Case (17)

[Muna1]

A confused 60 year man is brought by ambulance to  ER .his dougter tells that he is heavey smoker and that he has had repeated admission with recurrent chest infection .she also says that her father has a chronic chough and can walk 100 yards befor he has to stop becuse of shortness of breath . the chest x-ray shows hyperinflated lunghs and right basal consolidation . arterial blood gas analysis shows the following:
pao2=16kpa, paco2=9kpa, ph=7.20
what is the dignosis?

[Dr.Hersi]

diagnosis:
The case is most likely Chronic Obstructive Pulmonary disease (COPD) especially emphysema

-Pt is smoker which is important risk foctor for developing emphysema
-Arterial blood gases are law and CXR shows hyperinflated chest

-Close relatives of people with emphysema are more likely to develop the same disease
-Older age is a risk factor for emphysema Lung function normally declines with age

Other close differential diagnosis is lung cancer due to age + smoking

[Kassim]

COPD.
In addition  he has a Acute Respiratory Acidosis. low PH(7.20), and Hypercapnia (9).

[Muna1]

Correct answer  Dr kasem and Dr hersi  the diagnosis is COPD (chronic bronchitis in this case).
COPD has two types: Emphysema, Chronic bronchitis.but my question about  this case ABG shows pao2=16kpa, Paco2=9kpa, ph=7.20 but in COPD patient ABG shows hypoxia, low pao2, normal or raised Paco2.
The diagnosis is deterioration of COPD (chronic bronchitis due to supplemental of high concentration of oxygen mostly in ambulance which lead to hypoventilation , hypercapnia and impairment of the level of consciousness.


SO AVOID HIGH OXYGEN CONCENTRATION IN COPD PATIENT

[Admin]

Congratulations
The 15 points of this case goes to Dr.Hersi
Regards
Dr.Mahdi