Auto Rickshaw driver, 54/M, Smoker and Occasional Alcoholic presented with high fever(102.6F), Tachycardia and Tachypnoea and Dehydration. ABG, CBC, Serum Electrolytes, Urea, Creatinine and CXR attached. Please give your opinion about PD, DD and Management.



Its a case of LRTI cause Pneumonitis ( Xray showing Right middle zone consolidation )....Neutrophilic Leukocytosis with Anemia ..... Sepsis is causing AKI dts why renal function are deranged....Hyponatremia is due to acute points twrds poor prognosis ABG is acceptable (looks like its VBG) Start with Broad Spectrum Antibiotics and oxygen support....correct electrolytes....keep a close watch on saturation and vitals....Monitor urine output....

Thanks. Actually he is being managed in the same line, on NorAd support, Antibiotics, Hydration, Correction of Electrolytes, Oxygen, Nebulisation. Vitals stabilised in 7hours treatment.

Rt consolidation Sepsis AKI ABG- severe hypoxemia, respiratory alkalosis due to sepsis & hyperventilation Adv- sputum c/s, blood cultures, urine ex / legionella antigen Rx- maintain oxygenation, antibiotics, IV fluids, maintain urine output and supportive care. Rx-

Thanks. He is being managed in exactly same line with satisfactory results till time. Only thing I am considering HRCT after stabilised condition as, Primary cause may be a segmental bronchial obstruction. And CA needs to ruled out.

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Pt is criticality ill he is in septicemic shock due lung sepsis pneumonia rtmid zone with encapsulated effusion !empyema. He is in metabolic acidosis and hyponatrimia with deranged kft. Plt are low. So macro antibiotcs with added respiration iv fluids.keep urine output satisfactory.


X ray shows consolidation in right middle zone, abg shows compensatory respiratory alkalosis with hypoxaemia with hyponatremia, blood report shows anaemia with neutrophilic leucocytosis and kft deranged.. Oxygen inhalation Nebulisation Antipyretics and cold sponging for fever Antibiotics Vital monitoring Correct electrolyte imbalance Urine output monitoring

Critical ill. He need support intubation and FiO2 100%, he have right empiema need ABX adjust to AKIN (levofloxacin or moxifloxacin, or vancomycin, impipenem or meropenem), hyponatremia need to be verify, because 111 isn't life compatible, but if it was lesser to 120 need rehydrate with isosmolar solutions and hyperosmolar solutions on intervals in 96 hrs. Control fever without NSAI. Consider steroids for SIRS.

Agree to pts dehydrated

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Rt Pneumonitis Acute Renal insult ABG showing hypoxemia, hyponatremia Resp. Alkalosis due to septicaemia Go for blood n urine culture/sensitivity Sputum for AFB CBNAAT n culture Rx Maintain ABC Broad spectrum antibiotics, correct dyselectrolaemia I/O charting Fluid management

Rt upper lobe pneumonia ,with sepsis with acute kidney injury(AKI) ,ventilation,draw blood for culture before starting antibiotics,appropriate fluid management

Thanks. Yes it's AKI.

Acute bacterial pneumonia with sepsis hypoxia and resp alkalosis O2 broad spectrum antibiotics including those for anaerobic and atypical organisms


Rt MZ consolidation: respiratory acidosis; hyponatremia,acute(?)renal failure: Correct hyponatremia, O2 inhalation, correct dehydration, antibiotics as per eGFR


right consolidation with aki ; start broad spectrum antibiotics avoiding nephrotoxic drug; input output charting

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