Unconsciousness patient

Chief complaint A 59 y/o male was brought by the family with the complaint of unconsciousness after some exertion at home. Past medical history He has h/o COPD and family member noticed he was breathing heavily for whole day and then fell unconscious. Description On arrival patient noticed to be in severe distress, fast respiration and slightly responsive to verbal commands. Vitals HR: 85 beats/min; respiration: 27 breaths/min; blood pressure: 190/110 mmHg; and oxygen saturation: 94% by pulse oximetry. Lab reports Attached below ECG showed sinus rhythm without ST segment changes. Diagnosis Need your opinion.

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Very low pH 6.7 indicate severe acidosis PCO2 is normal 40 CO2 content has reduced - it indicates metabolic acidosis Increased Lactic acid indicate lactic acidosis is contributing to metabolic acidosis Overall this condition indicate Acute exacerbation of COPD with Type I respiratory failure causing hypoxia with lactic acidosis There is likely possibility of Superadded infection

Acute severe exacerbration of COPD with Accelerated Hypertension. Elevated lactate is common in COPD. Unconsciousness/drowsiness can be due to respiratory failure with acidosis or hypertensive encephalopathy. Adv CT brain plain 2D echo Chest radiograph

Accelerated hypertension/ hypertensive crisis. Adv cxray. ABG showing lactic acidosis. Neurological assessment,Sos get MRI brain done. Supportive treatment and management of hypertension.


It's a case of acute exacerbation copd with severe acidosis with lactic acidosis with accelerated htn with type 1 respiratory failure See for ecg and Chest xray See for ct brain See for hrct See for blood report n esr Thyroid profile Rule out stroke or Ketoacidosis See for urine routine

Acute exacerbation of COPD, lactic acidosis, accelerated hypertension ,may be strike as well . Rule out consolidation n cerebrovascular pathology through CT . Treat as diabetic ketoacidosis till other causes are ruled out

Metalic acidosis with sepsis with hypertension Control hypertension Bicarbonate s Admit in iccu underphysician Procalcitonin serum k T3t4 tsh

Diabetes. CT brain. And CVS are to be evaluated

Lactic acidos. Sodium biocarbonate IV.

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