Browsing by Author "Regmi, Ashim"
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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 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.