Publication: A case report of a COPD patient presented in severe metabolic alkalosis Authors
Date
2022
Journal Title
Journal ISSN
Volume Title
Publisher
Nepalese Respiratory Society
Abstract
Abstract:
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.
Description
Ashish Shrestha
Department of pulmonary, critical care and sleep medicine, Nepal Mediciti Hospital
Naresh Gurung
Department of pulmonary, critical care and sleep medicine, Nepal Mediciti Hospital
Ashish Karthak
Department of pulmonary, critical care and sleep medicine, Nepal Mediciti Hospital
Sanjeet Bhattarai
Department of pulmonary, critical care and sleep medicine, Nepal Mediciti Hospital
Rakesh Lama
Department of pulmonary, critical care and sleep medicine, Nepal Mediciti Hospital
Utsav Kumar Shrestha
Department of pulmonary, critical care and sleep medicine, Nepal Mediciti Hospital
Kishor Khanal
Department of critical care, Nepal Mediciti Hospital
Anup Ghimire
Department of critical care, Nepal Mediciti Hospital
Ashim Regmi
Department of critical care, Nepal Mediciti Hospital
Sanjeet Krishna Shrestha
Department of pulmonary, critical care and sleep medicine, Nepal Mediciti Hospital
Keywords
Chronic Obstructive Pulmonary Disease, Respiratory Failure, Non Invasive ventilation, Metabolic Alkalosis