Case Acute Shortness of Breath: ICM 2
Case Acute Shortness of Breath: ICM 2
Case Acute Shortness of Breath: ICM 2
continues to smoke but has recently “cut down” her cigarette use. She uses bronchodilator
inhalers only “as needed.” She received a course of antibiotics for an exacerbation of her
chronic obstructive pulmonary disease ∼2 months ago, but she does not remember the
name of the antibiotic.
on forced expiration. Abdominal examination was remarkable. No pitting edema was found
Investigation results: Chest X-ray showed; ECG : sinus tachycardia. Arterial blood gases
showed : pH 7.47; pO2 62 ; pCO2 : 48; HCO3: 20 mmol/L; BE : +2, SpO2: 91%, FiO2 80%.
The patient's laboratory test results are as follows: hemoglobin level, 14 g/dL;
hematocrit, 42%; WBC count, 19,000 cells/µL with 85% neutrophils 9% lymphocytes; and
platelet level, 110,000 cells/µL. Electrolyte levels are as follows: Na+, 132 mg/dL; K+, 3.8
mg/dL; chloride, 115 mg/dL; The patient's blood urea nitrogen (BUN) level is 35 mg/dL, and
her creatinine level is 1.2 mg/dL eGFR 80. SGOT 22 SGPT 20, hsCRP 206, RBG 320 mg/dl.
Mrs Shorta was admitted to mechanical ventilation. she was given intravenous fluids
and empirical intravenous ceftriaxone, azithromycin and high dose corticosteroid through a
peripheral vein. Sputum and blood culture was obtained. She was discharged with follow up
in diabetes and COPD treatment. She was given pneumococcus and influenza vaccine and stop
smoking management.
1
Figure 1. Shorta,, 56 years old female, chest xray on admission