Case of Acute Bronchiectasis
15/12/21 with chief complaints of Shortness of breath
since 3 months, fever since 7 days,cough since 10
days and decreased urine output since 2 days.
HISTORY OF PRESENT ILLNESS:
Patient was apparently asymptomatic 3 months back
after which she developed SOB which was insidious in
onset with orthopnea.
Patient developed cough since 10 days with
expectoration (mucoid, minimal, foul smelling and not
blood stained) increased on lying down and decreased
when sitting down.
Patient complaints of fever since 7 days with chills.
Decreased urine output since 2 days .
Patient had history of tuberculosis 6 years back for
which she was on medication for 8 months and cured completely .
Patient is not known case of diabetes mellitus ,hypertension and ischemic heart disease.
- h/o similar complaints for the past 6 months(became severe since 10 days .
Patient is labor worker by occupation and she may be exposed to biomass and dust since 25 years.
Patient was admitted to pulmonology department where she was intubated on 17 /12/21.
On 19/12/21 one whole Blood transfusion was done(2 FFP+ 1 PRBC)
GENERAL EXAMINATION:
Patient was consious and cooperative
No signs of pallor, cyanosis, clubbing and edema.
Vitals:
Temperature: afebrile
Pr: 120 bpm
Rr: 39cpm
Bp: 140/90 mmhg
Grbs: 141 mg/dl
Cvs: s1 and s2 heard
Investigations on admission:
Hb: 12.3
Tlc: 24000
Plt. Count: 4.40
LFT:
TB: 1 54
DB: 0.40
AST: 48
ALT: 41
ALP: 351
TP: 7.5
ALB: 3.4
16/12/21
ABG:
PH: 7.34
PCO2: 94.6
PO2: 81.8
HCO3-: 50.3
St.HCO3- : 44.9
Hb: 9.6
Tlc: 14200
Plt count: 3.34
17/12/21:
Na+: 145
K+: 4.2
Cl-: 93
ABG:
PH: 7.35
PO2 : 84.9
PCO2: 77.7
HCO3-: 42.6
St. HCO3-: 38.3
Na+: 145
K+: 3.7
Cl-: 92
Urine for ketone bodies: negative
Blood urea : 29
Cretainine: 0.6
RFT:
UREA: 35
CREAT: 1.0
UA: 7.5
Ca2+ : 10.0
Na+ : 140
K+ : 3.7
Cl- : 92
K+ : 3.7
ABG:
PH: 7.32
PCO2: 119
PO2: 67.4
HCO3- : 60.0
St. HCO3- : 52.1
Provisional diagnosis:
Acute exacerbation of brochiectasis with type 2 Respiratory failiure with pulmonary hypertension with post TB sequelae.
Treatment
1. INJ. PIPTAZ 4.5 GM IV TID
2. TAB. AZITHROMYCIN 500MG OD
3. INJ. HYDROCORT 100MG IV TID
4. INJ. LASIX 20MG IV BD if sbp more than 110 mmhg
5. O2 inhalation at 6 to 8 liters per min
6. NIV with BIPAP continuously with 2 hours gap after meals
7. Neb. With duolin 4th hourly and budecort 8th hourly and mucomist 2nd hourly
8. Syp. AROSTOZYME 2tbsp TID
9. Syp. ASCORYL 2 Tbsp TID
10. T. PCM 650MG SOS
11. Inj. PAN 40 mg IV BD
TREATMENT IN MEDICINE DEPARTMENT
1. 1 WHOLE BLOOD TRANSFUSION
2. INJ. MIDAXOLAM AT 6 MG/HR
3. INJ. PANTOP 40MG IV OD
4. INJ. PIPTAZ 4.5 GM IV TID
5. T. AZITHROMYCIN 500MG IV BD RT
6. INJ. HYDROCORT 100MG IV BD
7. INJ TRANEXA 500MG IV BD
8. INJ. VIT K 10MG IN 100ML NS IV STAT
9. T. SILDENAFIL 20MG RT TID
10. IVF NS RL AT 75 ML/HR
11. AIR/ WATER BED
12. INJ. VASOPRESSIN 1 AMP IN 50 ML NS AT 1.6 ML/ HR
13. INJ. CLINDAMYCIN 600 MG IV TID
14. ET SUCTUON + ORAL SUCTION HOURLY.
Really well studied and reported. Thanks for publishing!
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