Browsing by Author "Ghimire, Anup"
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Publication A case report of a COPD patient presented in severe metabolic alkalosis Authors(Nepalese Respiratory Society, 2022) Shrestha, Ashish; Gurung, Naresh; Karthak, Ashish; Bhattarai, Sanjeet; Lama, Rakesh; Shrestha, Utsav Kumar; Khanal, Kishor; Ghimire, Anup; Regmi, Ashim; Shrestha, Sanjeet KrishnaAbstract: Chronic Obstructive Pulmonary Disease (COPD) patients generally present with respiratory acidosis and type 2 respiratory failure. Here we present a case of 65 years old female, who is a known case of COPD and presented in our emergency department with severe metabolic alkalosis (pH 7.730, HCO3- greater than 99.9mmol/l). She was referred from other center after the development of seizure. Urinary sodium was sent which indicated the cause of metabolic alkalosis was contraction alkalosis; we then treated the patient with IV fluids, antibiotics and Mechanical Ventilator. Arterial Blood gas analysis was initially done every 4 hours till the pH was corrected. After pH was corrected the patient was extubated to intermitted Non Invasive Ventilation (NIV) for type 2 respiratory failure. With pulmonary rehabilitation we could discharge the patient with inhalers; without the need for NIV or supplementary oxygen. This is one of the rare cases where the patient presented with a very high bicarbonate level, high partial pressure of carbon dioxide in arterial blood, and high pH. The patient was successfully managed with IV fluids and mechanical ventilation.Publication Intravenous Lipid Emulsion Therapy: A Crucial Approach for Treating Lipophilic Drug Poisoning- A Case Study from Nepal(Nepalese Respiratory Society, 2024) Poudel, Saroj; Khanal, Kishor; Ghimire, Anup; Shrestha, Pallawi; Rijal, Bishakha; Shrestha, Aastha; Shyaka, Selika; Shrestha, Akchhyeta; Bikram, YogeshAbstract: Intravenous lipid emulsion (ILE) therapy has emerged as a promising treatment for lipophilic drug poisoning, particularly in cases where conventional therapies fail. This case study from Nepal highlights the successful use of ILE therapy in treating a severe calcium channel blocker (CCB) overdose. A 37-year-old female patient with an intentional amlodipine overdose presented with bradycardia, hypotension, and metabolic acidosis. Despite initial treatment with high-dose insulin, calcium gluconate, and inotropic support, her condition remained critical. The initiation of ILE therapy led to rapid hemodynamic stabilization, allowing the discontinuation of vasopressors and normalization of metabolic parameters within 24 hours. The patient recovered without adverse effects and was discharged in stable condition. This case underscores the potential of ILE therapy as a life-saving intervention in severe CCB toxicity and highlights the need for further research to optimize its use in clinical practice.Publication Pulmonary Mucormycosis secondary to Severe Acute Respiratory Illness due to Covid 19 Infection: A Case Report Authors(Nepalese Respiratory Society, 2022) Karthak, Ashish; Shrestha, Ashish; Gurung, Naresh; Bhusal, Yuvaraj; Lama, Rakesh; Rayamajhi, Sulav; Bhattarai, Sanjeet; Regmi, Asim; Ghimire, Anup; Khanal, Kishor; Shrestha, Sanjeet KAbstract: Patients diagnosed and hospitalized with SARS COV-2 are managed with corticosteroids due to its known benefits for the prevention of airway inflammation secondary to acute respiratory distress syndrome seen commonly in viral pneumonia. However, these patients carry a high risk of developing secondary bacterial and fungal infection. We present a case of 60-year-old male with COVID-19 pneumonia. The patient was diagnosed with pulmonary mucormycosis 18 days following admission. The patient was treated with broad-spectrum antibiotics, remdesivir and corticosteroids along with antifungals including voriconazole and amphotericin B with no significant improvement. However, even after extensive medical management patient was eventually intubated and succumbed to its complications. Mucormycosis although an uncommon infection should be considered due to extensive use of glucocorticoid therapy and concurrent comorbidities present among COVID-19 patients.Publication Role of Tranexamic acid in NSAIDS induced angioedema(Nepalese Respiratory Society, 2023) Chalise, Rupak; Poudel, Saroj; Bist, Manoj; Regmi, Ashim; Ghimire, Anup; Khanal, KishorAbstract: Tranexamic acid (TXA) is an antifibrinolytic agent that inhibits the conversion of plasminogen to plasmin, a key step in kallikrein activation and bradykinin formation. Tranexamic acid is used in the prophylactic management of hereditary angioedema; however, evidence for TXA in Non-Steroidal Anti-inflammatory drug-induced angioedema (NSAIDS-AE) is limited. We describe a patient who presented to the ICU department with NSAIDS-AE and was successfully treated with TXA. This case suggests that TXA may be a beneficial treatment modality in the management of NSAIDS-AE and warrants further investigation.