A Case Report: Co-presenting COVID-19 Infection and Acute Drug Intoxication

Background: Coronavirus disease 2019 (COVID-19) has spread throughout the world since late 2019. Symptoms appear after a two-week incubation period and commonly include fever, cough, myalgia or fatigue, and shortness of breath. Case Report: A 32-year-old male with a history of opiate abuse presented to the emergency department with altered mental status. The patient was lethargic and hypoxic with improvement from naloxone. Official chest radiograph was read as normal; however, the treating clinicians noted bilateral interstitial opacities, raising concern for underlying infectious etiology. Opiates and cocaine were positive on drug screen, and an arterial blood gas on room air showed hypoxemia with respiratory acidosis. The patient was intubated during the treatment course due to persistent hypoxemia and for airway protection after resuscitation. The COVID-19 test was positive on admission, and later computed tomography showed ground-glass opacities. The patient was extubated and discharged after one week on the ventilator. Conclusion: When screening patients at and during evaluation, physicans should consider a broad differential as patients with atypical presentations may be overlooked as candidates for COVID-19 testing. As screening and evaluation protocols evolve, we emphasize maintaining a high index of suspicion for COVID-19 in patients with atypical symptoms or presenting with other chief complaints in order to avoid spreading the disease.

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Causes, Effects and Methods of Monitoring Gas Exchange Disturbances during Equine General Anaesthesia

Animals ◽

10.3390/ani11072049 ◽

2021 ◽

Vol 11 (7) ◽

pp. 2049

Author(s):

Elżbieta Stefanik ◽

Olga Drewnowska ◽

Barbara Lisowska ◽

Bernard Turek

Keyword(s):

Gas Exchange ◽

General Anaesthesia ◽

Near Infrared ◽

Respiratory Acidosis ◽

Monitoring Methods ◽

Arterial Blood Gas ◽

Complementary Method ◽

Arterial Blood ◽

Operative Complications ◽

Post Operative Complications

Horses, due to their unique anatomy and physiology, are particularly prone to intraoperative cardiopulmonary disorders. In dorsally recumbent horses, chest wall movement is restricted and the lungs are compressed by the abdominal organs, leading to the collapse of the alveoli. This results in hypoventilation, leading to hypercapnia and respiratory acidosis as well as impaired tissue oxygen supply (hypoxia). The most common mechanisms disturbing gas exchange are hypoventilation, atelectasis, ventilation–perfusion (V/Q) mismatch and shunt. Gas exchange disturbances are considered to be an important factor contributing to the high anaesthetic mortality rate and numerous post-anaesthetic side effects. Current monitoring methods, such as a pulse oximetry, capnography, arterial blood gas measurements and spirometry, may not be sufficient by themselves, and only in combination with each other can they provide extensive information about the condition of the patient. A new, promising, complementary method is near-infrared spectroscopy (NIRS). The purpose of this article is to review the negative effect of general anaesthesia on the gas exchange in horses and describe the post-operative complications resulting from it. Understanding the changes that occur during general anaesthesia and the factors that affect them, as well as improving gas monitoring techniques, can improve the post-aesthetic survival rate and minimize post-operative complications.

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P-Chloroaniline Poisoning Causing Methemoglobinemia: A Case Report and Review of the Literature

Case Reports in Emergency Medicine ◽

10.1155/2015/208732 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4

Author(s):

Anna Sarah Messmer ◽

Christian Hans Nickel ◽

Dirk Bareiss

Keyword(s):

Case Report ◽

Blood Gas Analysis ◽

Gas Analysis ◽

Peripheral Oxygen Saturation ◽

Arterial Blood Gas ◽

Oxygen Administration ◽

Arterial Blood ◽

Arterial Blood Gas Analysis ◽

Common Causes ◽

Treatable Condition

Background. Methemoglobin (MetHb) most commonly results from exposure to an oxidizing chemical but may also arise from genetic, dietary, or even idiopathic etiologies.P-chloroaniline (PCA) was one of the first substances described in the context of acquired methemoglobinemia.Case Report. We report the case of a cyanotic chemistry worker who presented to our emergency department (ED) after working with PCA. His peripheral oxygen saturation (SpO2) measured by pulse oximetry was at 81% and remained on that level despite oxygen administration (100% oxygenation via nonrebreather mask). His MetHb level was measured at 42.8% in arterial blood gas analysis. After treatment with intravenous methylene blue cyanosis resolved and the patient was discharged after 36 hours of observation.Conclusion. Acquired methemoglobinemia is a treatable condition, which may cause significant morbidity and mortality. The knowledge about the most common causes, fast diagnostic, and proper treatment is crucial.

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Apnoeic oxygenation using transnasal humidified rapid-insufflation ventilatory exchange during rigid bronchoscopy: a report of four cases

Journal of International Medical Research ◽

10.1177/03000605211068309 ◽

2022 ◽

Vol 50 (1) ◽

pp. 030006052110683

Author(s):

Jaewoong Jung ◽

Juhui Park ◽

Misoon Lee ◽

Yang-Hoon Chung

Keyword(s):

General Anaesthesia ◽

Flow Rate ◽

Outlet Obstruction ◽

Respiratory Acidosis ◽

Bronchial Tube ◽

Rigid Bronchoscopy ◽

Gas Analysis ◽

Arterial Blood Gas ◽

Arterial Blood ◽

Apnoeic Oxygenation

General anaesthesia with a muscle relaxant is usually performed for rigid bronchoscopy (RB), but ventilation is challenging due to large amounts of leakage. Optiflow™ supplies 100% humidified, warmed oxygen at a rate of up to 70 l/min and this high flow rate may overcome the leakage problem. This case report describes four patients that were scheduled for RB. The lung lesions were all located below the carina, so a bronchial tube was inserted under general anaesthesia. Once a large amount of leakage was confirmed by manual ventilation, Optiflow™ was connected to the bronchial tube (flow rate, 70 l/min). All of the ports of the bronchoscopy were left open to prevent the risk of outlet obstruction. Oxygenation was well maintained with stable vital signs throughout the procedures, which took up to 34 min without airway intervention. There were no occurrences of cardiac arrhythmia or changes in the electrocardiograms. Respiratory acidosis recovered after emergence, which was confirmed by arterial blood gas analysis in all cases. Apnoeic oxygenation using Optiflow™ was applied successfully during RB. Applying Optiflow™ could make cases of difficult ventilation during RB much easier for the anaesthetist. Larger studies need to demonstrate the efficacy and safety of this technique.

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Intubation prognosis in COVID-19 patients and associated factors: a cross-sectional study

10.21203/rs.3.rs-115894/v1 ◽

2020 ◽

Author(s):

Mostafa Mohammadi ◽

Hesam Aldin Varpaei ◽

Majid Amini

Keyword(s):

Clinical Signs ◽

Respiratory Acidosis ◽

Absolute Lymphocyte Count ◽

Clinical Severity ◽

Common Finding ◽

Cross Sectional ◽

Arterial Blood Gas ◽

Laboratory Parameters ◽

Arterial Blood ◽

Wide Range

Abstract Background: In December 2019, a new pathogen, HCoV, or New Corona Virus 2019 (2019-nCoV), was recognized in Wuhan, China, causing a pandemic. COVID-19 has a wide range of clinical severity. Approximately 3.2% of patients within some periods of the disease require intubation and invasive ventilation. Methods: This study was descriptive-analytical and was conducted in the Imam Khomeini Hospital. Patients with Covid-19 who required endotracheal intubation were identified and their clinical signs and laboratory parameters were recorded. SPSS23 software was used for statistical analysis. Results: 120 patients with coronavirus with different conditions were evaluated. The mean age was 55±14. 30 patients had cardiovascular disease (hypertension) and 20 endocrine disease(diabetes). Respiratory acidosis, decreased oxygen saturation, lymphopenia, and increased CRP were the most common finding before intubation. 31 patients had no comorbidity conditions. However, 27 patients had more than one comorbidity condition, and 23 experienced acute respiratory distress syndrome. The mortality rate was 49.2%. Discussion: Although all laboratory parameters and patients symptoms can affect the treatment outcome, it was found that WBC and absolute lymphocyte count, BUN, SOFA and APACHE scores, inflammatory index ratio CRP / LDH % CRP / ESR% and ESR / LDH%, arterial blood gas indices, pulse rate, and patient temperature before intubation are among the parameters that can affect the patient's 14-day prognosis. Conclusion: Except for the mentioned items, CRP / LDH% ratio seems to be a good indicator for checking the prognosis of discharge or death of patients within 14 days, However, CRP / ESR% and ESR / LDH% are appropriate criteria for determining the prognosis for discharge or stay in the ICU for more than 14 days.

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Successional occurrence of two papulosquamous disorders in HIV positive patient: a rare case report

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20214216 ◽

2021 ◽

Vol 7 (6) ◽

pp. 869

Author(s):

Nitika Sanjay Deshmukh ◽

Ravindranath Brahmadeo Chavan ◽

Anil Prakash Gosavi ◽

Supriya Ashok Kachare

Keyword(s):

Case Report ◽

Lichen Planus ◽

Lupus Erythematosus ◽

Rare Condition ◽

Discoid Lupus Erythematosus ◽

Rare Presentation ◽

Rare Case Report ◽

Autoimmune Conditions ◽

Atypical Presentations ◽

High Index Of Suspicion

<p class="abstract">Presentation of two papulosquamous disorders in a same individual is rare condition till date. Independently, psoriasis and Lichen planus (LP) are common inflammatory skin conditions affecting around 2-3% and 1% of HIV (Human immune deficiency) positive population respectively. As reviewed in the literature, psoriasis may be independently associated with other autoimmune conditions like vitiligo, alopecia areata, lichen planus, and discoid lupus erythematosus. In this article, we presented a case report of a HIV seropositive patient who suffered from psoriasis and lichen planus. The coexistence of psoriasis and lichen planus in one individual is rare and underreported in literature. Psoriasis or lichen planus may be the presenting feature of HIV infection and tends to be more severe, to have atypical presentations. Psoriasis and lichen planus can be coexistent or successionally appear one after other in one individual though rare presentation. High index of suspicion is always required while dealing with papulosquamous lesions in PLHIV.</p><p> </p>

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THE STUDY ON ARTERIAL BLOOD GAS IN PATIENTS WITH ACUTE STROKE

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2017.4.5 ◽

2017 ◽

pp. 37-45

Author(s):

Xuan Tai Nguyen ◽

Dinh Toan Nguyen

Keyword(s):

Ischemic Stroke ◽

Acute Stroke ◽

Scale Score ◽

Negative Correlation ◽

Hemorrhagic Stroke ◽

Respiratory Acidosis ◽

Blood Gas ◽

Arterial Blood Gas ◽

Arterial Blood ◽

Time Of Admission

Objectives: 1) To investigate the variation in arterial blood gas in patients with acute stroke according to ischemic stroke and hemorrhagic stroke. 2) To determine the correlation and relevance between arterial blood gas and Glasgow scale score, NIHSS, volume of brain damage on computed tomography imaging. Subjects and methods: A cross-sectional study was done in 70 patients with acute stroke. Results: Reduced rates of PCO2, PO2, SaO2 at the time of admission were 56.2%, 25%, 18.8% in ischemic stroke and 44.4%, 72.2%, 63% in hemorrhagic stroke. At the time of 24 hours, these rates were 75%, 56.2%, 50% in ischemic stroke and 50%, 79.6%, 70.4% in hemorrhagic stroke. At the time of 48 hours, these rates were 68.7%, 50%, 18.8% in ischemic stroke and 53.7%, 59.3%, 44.4% in hemorrhagic stroke. Respiratory acidosis was only present at hemorrhagic stroke. Respiratory alkalosis was in both stroke style and had the highest proportion. At the time of admission, SaO2 was negatively correlated with damage volume (r=- 0.264, p<0.05). HCO3- correlated with Glasgow (r=0.323; p<0.01) and NIHSS (r=-0.274; p<0.05). At the time of 24 hours, there was a negative correlation between PO2 (r=-0.375, p=0.001) and SaO2 (r =-0.39, p<0.01) with NIHSS. There was a negative correlation between PO2 (r=-0.435) and SaO2 (r=-0.457) with damage volume (p <0.0001). At the time of 48 hours, there was a negative correlation between PCO2, PO2 and SaO2 with NIHSS (r=-0.312, p<0.01, r=-0.35, p=0.01 and r=-0.0270, p<0.05). PCO2 was positively correlated with Glasgow (r = 0.260, p <0.05). There was a negative correlation between PO2 (r = - 0.391, p = 0.001) and SaO2 (r = - 0.421, p <0.001) with damage volume. Conclusions: In stroke patients, disturbances on ABG they are surfered from (acid-base disorders, hypoxemia) affect directly or indirectly on brain cells. Secondary brain damages could be well prevented if these disturbances is diagnosed and treated promptly. Key words: Stroke, arterial blood gas, Glasgow scale score, NIHSS

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Diabetic ketoacidosis, hyperuricemia and encephalopathy intractable to regular-dose insulin

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2017-0225 ◽

2017 ◽

Vol 30 (12) ◽

Author(s):

Jillian Gregory ◽

Sonali Basu

Keyword(s):

Metabolic Acidosis ◽

Diabetic Ketoacidosis ◽

Insulin Infusion ◽

Work Of Breathing ◽

Altered Mental Status ◽

Inborn Errors ◽

Case Presentation ◽

Arterial Blood Gas ◽

Arterial Blood ◽

History Of

AbstractBackground:Diabetic ketoacidosis (DKA) in children less than 1 year of age is a rare occurrence. Typical presentation includes a prodrome of weight loss and polyuria with subsequent presentation to medical care when acidosis becomes symptomatic.Case presentation:We describe an unusual case of a previously healthy infant with a 3 days’ history of constipation, presenting acutely with abdominal pain, lethargy, and dehydration. On initial evaluation, our patient had profound encephalopathy, with marked tachypnea and work of breathing. Arterial blood gas revealed a pH of 6.9, pCO2 of 20 and a bicarbonate level of <5. There was profound leukocytosis (WBC 77 K/μL), hyperuricemia (uric acid 15.9 mg/dL), and evidence of pre-renal azotemia [blood urea nitrogen (BUN) 54, Cr 0.82]. Blood glucose was >700 mg/dL. Despite fluid resuscitation and insulin infusion of 0.1 unit/kg/h, which are the mainstays of therapy for DKA, her severe metabolic acidosis and altered mental status did not improve. Differential diagnosis for her metabolic derangements included inborn errors of metabolism, insulin receptor defects, toxic ingestions, and septic shock secondary to an underlying oncologic or intra-abdominal process. The patient was treated with broad spectrum antibiotics and rasburicase. She continued to have significant shock for the first 30 h of her hospital stay, requiring moderate vasoactive support. Due to her refractory acidosis and persistent hyperglycemia, insulin infusion was increased to 0.15 units/kg/h. A hemoglobin AConclusions:Metabolic acidosis in an infant requires a broad differential. Rasburicase should be considered in hyperuricemia and DKA.

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Flexible bronchoscopy and mechanical ventilation in managing Mounier-Kuhn syndrome: a case report

Sao Paulo Medical Journal ◽

10.1590/1516-3180.20160336270117 ◽

2017 ◽

Vol 136 (3) ◽

pp. 266-269

Author(s):

Aslihan Gürün Kaya ◽

Aydin Çiledağ ◽

Çetin Atasoy ◽

Demet Karnak

Keyword(s):

Mechanical Ventilation ◽

Case Report ◽

Invasive Mechanical Ventilation ◽

Respiratory Acidosis ◽

Flexible Bronchoscopy ◽

Positive Pressure ◽

Laboratory Findings ◽

Non Invasive ◽

Arterial Blood ◽

Congenital Condition

ABSTRACT CONTEXT: Mounier-Kuhn syndrome is a rare congenital condition with distinct dilatation and diverticulation of the tracheal wall. The symptoms may vary and the treatment usually consists of support. CASE REPORT: The patient was a 60-year-old male with recurrent hospital admission. He was admitted in this case due to dyspnea, cough and sputum production. An arterial blood sample revealed decompensated respiratory acidosis with moderate hypoxemia. A chest computed tomography (CT) scan showed dilatation of the trachea and bronchi, tracheal diverticula and bronchiectasis. Flexible bronchoscopy was performed, which revealed enlarged airways with expiratory collapse. Furthermore, orifices of tracheal diverticulosis were also detected. Non-invasive positive pressure ventilation (NPPV) was added, along with long-term oxygen therapy. At control visits, the patient’s clinical and laboratory findings were found to have improved. CONCLUSION: Flexible bronchoscopy can be advocated for establishing the diagnosis and non-invasive mechanical ventilation can be used with a high success rate, for clinical wellbeing in Mounier-Kuhn syndrome.

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Automatic real-time analysis and interpretation of arterial blood gas sample for Point-of-care testing: Clinical validation

PLoS ONE ◽

10.1371/journal.pone.0248264 ◽

2021 ◽

Vol 16 (3) ◽

pp. e0248264

Author(s):

Sancho Rodríguez-Villar ◽

Paloma Poza-Hernández ◽

Sascha Freigang ◽

Idoia Zubizarreta-Ormazabal ◽

Daniel Paz-Martín ◽

...

Keyword(s):

Metabolic Acidosis ◽

Metabolic Alkalosis ◽

Point Of Care ◽

Respiratory Acidosis ◽

Blood Gas ◽

Acid Base ◽

Predictive Values ◽

Arterial Blood Gas ◽

Arterial Blood ◽

Global Accuracy

Background Point-of-care arterial blood gas (ABG) is a blood measurement test and a useful diagnostic tool that assists with treatment and therefore improves clinical outcomes. However, numerically reported test results make rapid interpretation difficult or open to interpretation. The arterial blood gas algorithm (ABG-a) is a new digital diagnostics solution that can provide clinicians with real-time interpretation of preliminary data on safety features, oxygenation, acid-base disturbances and renal profile. The main aim of this study was to clinically validate the algorithm against senior experienced clinicians, for acid-base interpretation, in a clinical context. Methods We conducted a prospective international multicentre observational cross-sectional study. 346 sample sets and 64 inpatients eligible for ABG met strict sampling criteria. Agreement was evaluated using Cohen’s kappa index, diagnostic accuracy was evaluated with sensitivity, specificity, efficiency or global accuracy and positive predictive values (PPV) and negative predictive values (NPV) for the prevalence in the study population. Results The concordance rates between the interpretations of the clinicians and the ABG-a for acid-base disorders were an observed global agreement of 84,3% with a Cohen’s kappa coefficient 0.81; 95% CI 0.77 to 0.86; p < 0.001. For detecting accuracy normal acid-base status the algorithm has a sensitivity of 90.0% (95% CI 79.9 to 95.3), a specificity 97.2% (95% CI 94.5 to 98.6) and a global accuracy of 95.9% (95% CI 93.3 to 97.6). For the four simple acid-base disorders, respiratory alkalosis: sensitivity of 91.2 (77.0 to 97.0), a specificity 100.0 (98.8 to 100.0) and global accuracy of 99.1 (97.5 to 99.7); respiratory acidosis: sensitivity of 61.1 (38.6 to 79.7), a specificity of 100.0 (98.8 to 100.0) and global accuracy of 98.0 (95.9 to 99.0); metabolic acidosis: sensitivity of 75.8 (59.0 to 87.2), a specificity of 99.7 (98.2 to 99.9) and a global accuracy of 97.4 (95.1 to 98.6); metabolic alkalosis sensitivity of 72.2 (56.0 to 84.2), a specificity of 95.5 (92.5 to 97.3) and a global accuracy of 93.0 (88.8 to 95.3); the four complex acid-base disorders, respiratory and metabolic alkalosis, respiratory and metabolic acidosis, respiratory alkalosis and metabolic acidosis, respiratory acidosis and metabolic alkalosis, the sensitivity, specificity and global accuracy was also high. For normal acid-base status the algorithm has PPV 87.1 (95% CI 76.6 to 93.3) %, and NPV 97.9 (95% CI 95.4 to 99.0) for a prevalence of 17.4 (95% CI 13.8 to 21.8). For the four-simple acid-base disorders and the four complex acid-base disorders the PPV and NPV were also statistically significant. Conclusions The ABG-a showed very high agreement and diagnostic accuracy with experienced senior clinicians in the acid-base disorders in a clinical context. The method also provides refinement and deep complex analysis at the point-of-care that a clinician could have at the bedside on a day-to-day basis. The ABG-a method could also have the potential to reduce human errors by checking for imminent life-threatening situations, analysing the internal consistency of the results, the oxygenation and renal status of the patient.

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Case Report: Nitrofurantoin-induced interstitial lung disease

F1000Research ◽

10.12688/f1000research.6245.1 ◽

2015 ◽

Vol 4 ◽

pp. 85

Author(s):

Suhail Basunaid ◽

Helena Pilate ◽

Melanie Schoutteten ◽

Rooy Sprooten

Keyword(s):

Interstitial Lung Disease ◽

Lung Disease ◽

Respiratory Acidosis ◽

Blood Gas Analysis ◽

Ct Scanning ◽

Gas Analysis ◽

Industrial Chemicals ◽

Arterial Blood Gas ◽

Arterial Blood

Nitrofurantoin is widely used for urinary tract infection (UTI) prophylaxis. Long-term use is known to be able to cause serious adverse effects including pulmonary and hepatic toxicity. The prevalence of nitrofurantoin-induced pulmonary injury is on the increase again as the drug regains popularity as a urinary antiseptic.We describe a previously healthy 83-year-old woman who presented to our emergency department in early 2012 with progressive dyspnoea since two weeks. This was not preceded by cough. She had no fever, wheezing, chest pain, or sputum production. She was a 50 pack per year ex-smoker. She had no previous exposure to tuberculosis or industrial chemicals. However, she suffered from recurrent symptomatic UTIs and was on a long-term prescription of nitrofurantoin for prophylaxis.Respiratory examination revealed dullness on percussion at both lung bases and widespread fine inspiratory crackles throughout both lungs. Arterial blood gas analysis showed hypoxia and complete compensation of respiratory acidosis.Initial treatment with co-amoxiclavulanic acid was initiated. CT scanning of the chest showed widespread ground-glass appearance in both lungs with organising pneumonia. A diagnosis of nitrofurantoin-induced interstitial lung disease (NIILD) was suspected. Nitrofurantoin was subsequently stopped and prednisone treatment at 30 mg OD was initiated. Follow-up chest X-ray showed marked improvement.

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