An Old Asthma Case

A 46-year-old male worked as an engineer, presented to our hospital with symptoms of progressively worsening shortness of breath over a period of 6 days. He was known to have a history of mild asthma with minimal symptoms and occasional use of inhalers prior to his hospital visit. His medical history included asthma diagnosed in childhood. What is diagnosis.. How this case should be managed?



Xray chest shows cardiomegaly Rt basal congestion+ H/o bronchial asthma Lab suggest Hyponatremia Deranged KFTS every thing is raised and eGFR is decreased Troponin t is strong +ve Marked eosinophilia Just going through above picture it looks pt had cardiac illness in recent past as troponin t suggest past illness Eosinophilia is consistent with progressive dysponea hence should immidiately be put on loading doses of hetrazan I surperise there is no blood sugar levels seen ?if pt is diabetic than whole picture changes in CKD with metabolic acidosis Pt has hyponatremia hence should be corrected with iv replacement Increase renal out by inj lasix Take ecg and 2decho to understand present cardiac condition sos opinion of cardiologist Manage asthma with nebulisation

Thanx dr Vipin Bihari Jain

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Hyponatremia is there Urea createnine is high eGfr 39 signfyCKD stage three Bicarbonate low signfy metabolic acidosis LDH is high Troponin is high. May be sign of heart disease. Likely Cadiorenal syndrome Chest x ray display hazzines on the lung bases bilateral. Covi 19 should be ruled out. And esinophilic bronchitis

Cardiomegaly LVH. Prominent Pulmonary arteries. Hypereosinophillia Loe bicarb Low GFR tropT positive Hyponatremia. Adv ECG Echo CD Swab for influenza typing including covid 19. AEC IgE level Asp specific antibodies IgM.

Screening for CoViD-19 by RT-PCR (no rapid testing) Elevated Urea & Creatinine, Reduced eGFR, Elevated Trop T, LDH, Creatinine kinase, Eosinophilia Seems to be MI with Nephropathy.

Asthmatic bronchitis Inj deriphylline 1amp + Inj dexona 2ml iv stat. Inj ceftam 500.g iv stat slowly. Antibiotics orally. Antihistamine orally. Tapering dose of steroid orally. Bronchodilator syp . Needs further investigation and evaluation to conclude and treatment plan. Raised eosinophil raised. Covid Infection and cardiac aliments should be ruled out.

Thanks Dr Kute Ankush

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CKD Hypernatremia Acidosis Elevated cardiac enzymes Xray shows cardiomegaly, right basal congestion . ? LVF , pulmonary edema ? MI ECG , ECHO needed . With the present prevalence of COVID cases, this could fit in with COVID infection ..RT PCR for COVID should be done .

Known case of Asthma with high eosinophils Urea and creatinine are also increased therefore treatment includes allergic bronchitis with investigations for renal dysfunction. Test for COVID-19 should be done


Tnx Dr Neha Jambla

Cardiomegaly +Rt.basal Pneumonia +Asthamatic Bronchitis +Renal disease +R/O Covid-19 Admission & evaluation

Thanks dr.Vipin bihari jain

CXR is s/o b/l lower lobe haziness,blood report shows hyponatremia,and hyperesinophillia.manegment consists of stepladder approach Mild to severe are as follows Short acting b2 agonist with ICS low dose to ICS high dose with LABA with OCS Plus higher antibiotics

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