Bronchial Asthma with type 2 respiratory failure

My mother till 1 1/2 year back she doesn't have any asthmatic symptoms . In the month of December 2018 she had developed cold (she attributes after eating Guava fruit). Cold is accompanied by sore throat and severe body aches and fever. We have consulted family physician who has given Anti histamines and antibiotics. It has not subsided. Discomfort became more especially while lying down. I checked with pulse oxymeter where it showed 65. I immediately shifted her to one of the corporate hospitals in Hyderabad.on Dec 19th 2018.They have done ABG tests. Pulmonologist said her PCO2 levels is 90 (it was said orally but not recorded in discharge summary) and she has to be put on Non invasive ventilation to wash out C02. Pulmonologist further said she had chronic asthma as she had bicarbonates in the blood. (It is surprising that she didn't report any dyspnoea even during work or walking before). Pulmonologist said if it doesn't work she has to be put on invasive ventilation. Fortunately she has progressed well. In four hours PCO2 levels are dropped to 66. Progressively her PCO2 levels have have decreased in a span of 3 days. On Dec 23rd her PCO2 levels are at 52. Her pH values at the time of admission is 7.19 and at the time of discharge is 7.53. Meanwhile she has undergone various investigations. Her CT chest showed mild right pleural effusion with consolidation.Ill definedl Nodular opacities in the lateral segment of right middle lobe -infective aetiology. Her 2D Echo showed concentric LVH+ and Grade 1 diastolic dysfunction others are normal. Her ultra sound abdomen showed liver size is normal with mild altered echotexture-to corelate with LFT. Bilateral Grade 1 renal parenchymal changes. Right minimal pleural effusion. LFT at the time of admission SGOT is 3809 SGPT 2368.All others are within limits. LFT at the time of discharge SGOT is 106 SGPT is 676. Hbs Ag test is negative. PT timing is 18.7 at the time of admission. At the time of discharge is 16.6. Her creatanine levels at the time of admission is 1.39 and at the time of discharge is 1.01. She was diagnosed Bronchial Asthma with type 2 respiratory failure and hepatitis with coagulopathy. For follow up review after a week she is again investigated. PCO2 are 49.5 pH value 7.49 PT timing is 14.6 SGOT is 27 SGPT is 84 Creatinine is 1.01. For whole 1 year she is feeling well. Her SPO2 saturation is above 93 most of the times. She is not having dyspnoea for most part except mild episodes not frequently. She is managed by bronchodilator Acebrophylline. Sometimes I give her nebulization of Duolin. Recently she had a fall and undergone partial hip replacement in the month of February 2020. After few days of hip joint replacement she developed suddenly discomfort and uneasiness and I checked her with pulse oxymeter. Her SPo2 is at 65. Again in the third week of March she is admitted in hospital and ABG tests are done. It showed PCO2 at 62. She was drowsy. She was put on NIV for 2 days. On the third day her PCO2 levels came down to 34. Her PH values at the time of admission is 7.26 and after 3 days 7.45. Her SGOT and SGPT levels are at 14. Her creatanine levels at 0.62 at the time of admission and discharge. Her 2 D echo showed same findings of last year and ectopic heart beat us seen during the test . Her HRCT chest showed linear atelctiasis at left lower lobe Lingular segment and bilateral pleural thickening with ? mild right plural effusion. The doctor has written hepatomegaly + in the case sheet. She was discharged in a span of 3 days and advised treatment. Treatment is as follows Pulmoclear, foracort nebulization, Amlong 5mg, Modalert , deviry and Dilzem. Doctor said Diltiazem is needed to treat atrial tachycardia which she experienced during hospital admission. After discharge she developed severe itching and Dermatologist advised Montek LC and Defacort 24 mg. She used Defacort 24 for 10 days OD. Itching is subsided. Now oflate she developed edema of both legs. More at the fractured part. Her asthmatic symptoms are ok. She has severe stomach uneasiness 4 hours after taking food. It is relieved after taking light snacks. She is put on Rantac 150 bid. Now those symptoms subsided 80 %. I would like to know what is the cause of edema of both legs. She is either sitting or lying down most of the times. She walks but not frequently. How it should be treated. Whether that is the reason for pedal edema. Why she is having tachypnea 30 times per minute I am observing her RR since from 1 year. She feels comfortable with that rate. Whether she needs physiotherapy breathing exercises to improve her lung capacity. Her CT scan chest only showed ateletic changes in small portion of the lung. She neither had Fibrosis or permanent pathology. I heard that hyperkapnia occurs due to obstruction of the air way. Is it due alveolitis. She is having back ache. For relief she used to take Tramadol. I observed 2 times that after taking Tramadol she is getting acute attack. Her CO2 levels have increased. I would like to know from distinguished doctors their opinion. Also treatment for edema.

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EDEMA FEET CAUSES 1 LONG TIME IMMOBLISATION & DVT FRACTUER PART IS .MORE DEPENDEND PART & HENCE MORE EDEMA 2 CH COR PULMONALE ( WITH CONGESTIVE HEPATOMEGALY ) 3 STEROID INDUCED 4 CCB = DILTIAZEM & AMLODIPINE 5 HAS HEPATOMEGALY WITH RAISED TRANSAMINASE LEVELS SERUM PROTEIN REPORT NOT AVAILABLE HYPOPROTEINAEMIA MAY BE A CAUSE
Thank you doctor
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