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?

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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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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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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.
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
? ASTHMATIC BRONCHITIS.. WITH..EOSINOPHILIA.. & ? CARDIAC PATHOLOGY.. NEED'S .. INVESTIGATIONS..TO CONCLUDE DIAGNOSIS AND TREATMENT.. HEMOGRAM.. SPUTUM STUDY.. ECG..2D ECHO STUDY.. COVID-19..
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.
Elevated cardiac enzymes, reduced renal function,mild cardiomegaly, bilateral basal haziness,may be a pointer to early CCF due to a mi.ecg and echo indicated.
Asthmatic bronchitis with cardiomegaly Bronchodilator Steroids Nebuliser with budicort and salbutamol Antibiotics Pul function test
Need ecg/Echo immediately because Here high Troponin with Renal failure X-ray s/o Cardiomegaly with haziness in both ll
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