Type2 respiratory failure 2°to aspiration pneumonia


30 years old male occupation Working as farmer came to our casualty at 9:15 AM on 13/2/2022 with the chief complaint of dyspnoea since 2 hours and and nausea since 2 hours


HOPI :

Patient is a resident of iskilla , farmer by occupation he mainly does sowing rice and labourer work .

patient was apparently asymptomatic on Saturday (12-2-2022) when he came home after consuming toddy from a place different from  his usual seller  around 2 bottles(360ml) (more than his usual consumption )and complained of back ache to his mother later few hours in he had 5-6 episodes of loose stools which were watery.

Later he felt hungry and asked his mother for some food .

He ate some rice and curry and asked for some milk. 

His mother gave him few drops of milk while he layed in supine position, later at around 3am he had two episodes of vomiting, vomitus was milk like in colour and non projectile, later developed bilateral limb weakness and sob,became deliriant .Seeing his condition his family members called for an ambulance and carried him into it because he couldn’t walk by himself .They reached the hospital at around 9am .


Past history : 

3yrs back his mother  wanted him to stop drinking and admitted in private hospital for 20-25 days. After 5-6 days of comming from hospital he started drinking again.

Not a known case of DM, HTN,TB,epilepsy, CAD, CVA.


Personal history :

Diet : mixed

Appetite : normal

Bowel and bladder moments : regular

Habits/addictions : he Is alcoholic since six years daily intake of whiskey 90 to 180 ML per day.

He chews tobacco one pack for day.


Family history : 

No significant family history


Genral examination : 

Patient is conscious, coherent , cooperative

No signs of pallor , icterus, clubbing , Sinuses lymphadenopathy , pedal edema.

 

Vitals : 

13/2                                         14/2

Temp : Afebrile.                    Afebrile

Bp : 150/90 mmHg.              180/100mmHg

Pr :  120 bpm.                         110bpm

Rr : 20 cpm.                            22cpm

Spo2 : 98% at ra

Grbs : 210mg%                     113mg%


Systemic examination : 



Cardiovascular system : s1 , s2 heard , no murmur 





Respiratory system : b/L respiratory crepts in all lung fields.



Per abdomen : soft , non-tender , no organomegaly.


INVESTIGATIONS:







HEMOGRAM: 

HB: 17.9

TLC: 4,000

N/L/E/M/B: 85/10/01/04/00

PCV: 53.4

MCV: 90.1

MCH: 30.2

MCHC:33.5

RBC:5.93

PT:2.06

RDW-CV :12.8

RDW-SD: 42.5

PS: NC/NC


RFT:

BLOOD UREA : 21mg/dl

SERUM CREATININE: 0.8 mg/dl

SERUM ELECTROLYTES:

Ca : 9.6

Na+ : 144

K+: 4.0

Cl-: 100


LFT

TB: 1.44

DB: 0.65

SGOT:40

SGOT:15

ALP: 169

TP:7.3

ALBUMIN:3.6

A/G: 1.36


Rbs : 125


Serum osmolality : 302.4


Serology : negative 


Complete urine examination :

Albumin : 3+

Sugar : 2+



             13/2       14/2.                                    15/2

             18.27     4.36.       5.01.       14.37.   7.27

PH:.        7.2          7.5.         7.3.          7.2     7.5

PCO2:.  48.5.      47.4.       37.8.       21.5     31.2

PO2:.   250.7.   62.4.        101.5.      137.9    93.2

HCO3 act:. 10.    38.2.       20.4.       9.5

HCO3std:.  18.4     37.6.        20.7.     11.9

Na+:.            139.7.  118.3.    138.7.    ?

K+:.               4.35     2.66.       3.64.      5.76

Ca+:.              4.7.      1.3         4.5.      Decrease

Cl:.                 105.      81.        105.    Decrease

Anion gap:    19.1.      1.8.       17.       

Glu:.                128.      85.        105.         62

Lac:.               1.78.      0.62.     1.22.         1.33



Provisional diagnosis : type2 respiratory failure secondary to ?aspiration pneumonia 


Treatment : 


1) head end elevation

2) inj.piptaz 2.25gm/iv/6th hrly

3) Nebuliaztions with mucomist 4th hrly and budecort 6th hrly

4) chest physiotherpay 12th hrly

5) inj.thiamine 1amp in 100ml Ns/iv/tid

6) monitor vitals hourly - bp,pr,spo2,rr

7) frequent suctioning of oral and nasal secretions


Discussion:



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