Question

A 55 year-old woman with a history of COPD presents to the emergency room with a two day history of worsening shortness of breath which came on following a recent viral infection possible COVID-19. In the emergency room, her oxygen saturation is 88% on room air. She is working hard to breathe and is only speaking in short sentences. On exam, she wheezes and a her respiratory rate is low. Her chest x-ray reveals changes consistent with COPD but she has new loss of tissue. An arterial blood gas (ABG) is done and shows pH 7.17, PCO2 is elevated PO2 is low, HCO3-is 35. What can we do for this patient? How do we remedy the situation for her? What is your diagnosis?

Answer 1

Treatment for the above patient must be based on the symptoms and clinical and laboratory findings. It should be as follows.

Correction of shortness of breath and wheezing.

correcting respiratory rate ( low RR): Bradypnea

Correcting elevated PCO2: hypoventilation

Correcting low levels of PO2: Respiratory insufficiency and hypoxemia.

Correcting pH 7.17: Alkaline

Correcting HCO3 level 35: Metabolic alkalosis

Here patient feels difficulty in breathing accompanied by low respiratory rate and wheezing. Arterial blood gas shows that she is having hypoxemia and she is hypoventilating. All these needs Oxygen supplement and other life supporting measures. Metabolic acidosis is corrected by giving diuretics which promote bicarbonate excretion. Normal saline also help in reducing alkalosis.

Since there is loss of tissue in x-ray finding the possible diagnosis is covid 19