|
The patient is a 62 year old male with a history of asbestos exposure
and interstitial lung disease diagnosed in 1995. He has been on steroids
since then and is currently on home O2 at 12 L. He was recently treated
for pneumonia and is on the lung transplant list. He presents today with
severe shortness of breath and is admitted to the hospital to the pulmonary
service for intubation and mechanical ventilation.
Urinalysis |
Result/Unit |
|
Ref Interval |
URINE COLLECTION |
NOT SPEC |
|
|
URINE COLOR |
YELLOW |
|
|
URINE APPEARANCE |
CLOUDY |
A |
|
SPECIFIC GRAVITY, URINE |
1.018 |
|
1.003-1.030 |
pH, URINE |
5.0 |
|
5.0-7.5 |
URINE PROTEIN |
NEG |
|
NEG |
URINE GLUCOSE |
NEG |
|
NEG |
URINE KETONES |
NEG |
|
NEG |
URINE BILIRUBIN |
NEG |
|
NEG |
URINE BLOOD |
SMALL |
A |
NEG |
URINE NITRITE |
NEG |
|
NEG |
URINE WBC SCREEN |
NEG |
|
NEG |
URINE RBC/HPF |
2-5 /HPF |
|
0-5/HPF |
URINE UROBILINOGEN |
0.2 mg/dL |
|
0.2-1.0 |
UR URIC ACID CRYSTALS |
MANY |
A |
|
Blood Gas |
Result/Unit |
|
Ref Interval |
FiO2 |
15 L |
|
|
pH |
7.439 |
|
7.35-7.45 |
PaCO2 |
29.1 mmHg |
L |
35-39 |
PaO2 |
52.7 mmHg |
L |
61-82 |
COHb |
0.7 % |
|
0.1-2 |
MethHb |
0.9 % |
|
0.1-2 |
tHb |
16.6 gm% |
|
13-19 |
O2 Content |
19.4 vol% |
|
17-24 |
Pb |
638 mmHg |
|
|
HCO3 |
19.4 mEq/L |
|
19-25 |
BE |
-2.9 mEq/L |
L |
-2.5-2.5 |
O2Hb |
83.4 % |
L |
92-99 |
Temp |
37 C |
|
|
Allen`s Test |
+ |
|
|
Name |
Result/Unit |
|
Ref Interval |
PROTHROMBIN TIME |
31.0 sec |
H |
12.0-15.5 |
INTERNATIONAL NORMALIZED RATIO |
3.0 ratio |
|
|
Name |
Result/Unit |
|
Ref Interval |
SODIUM |
132 mmol/L |
L |
136-144 |
POTASSIUM |
5.8 mmol/L |
H |
3.3-5.0 |
CHLORIDE |
96 mmol/L |
L |
98-107 |
CARBON DIOXIDE |
18 mmol/L |
L |
22-29 |
UREA NITROGEN |
34 mg/dL |
H |
9-22 |
CREATININE, SERUM - mg/dL |
1.9 mg/dL |
H |
0.8-1.5 |
GLUCOSE |
99 mg/dL |
|
64-128 |
ANION GAP |
18 mmol/L |
H |
8-14 |
CALCIUM, SERUM OR PLASMA |
8.8 mg/dL |
|
8.4-10.2 |
CBC with Dif |
Result/Unit |
|
Ref Interval |
WHITE BLOOD CELL COUNT |
29.64 K/uL |
H |
3.20-10.60 |
RED BLOOD CELL COUNT |
5.39 M/uL |
|
4.69-6.07 |
HEMOGLOBIN |
16.8 g/dL |
|
14.6-17.8 |
HEMATOCRIT |
49.3 % |
|
40.8-51.9 |
MEAN CORPUSCULAR VOLUME |
91.5 fL |
|
77.8-94.0 |
MEAN CORPUSCULAR HEMOGLOBIN |
31.2 pg |
|
26.5-32.6 |
MEAN CORPUSCULAR HGB CONC |
34.1 g/dL |
|
32.7-36.9 |
RED CELL DISTRIBUTION WIDTH |
17.9 % |
H |
10.8-14.1 |
PLATELETS |
301 K/uL |
|
177-406 |
MEAN PLATELET VOLUME |
8.9 fL |
|
5.9-9.8 |
GRANULOCYTES % |
86.6 % |
H |
44.0-76.0 |
MONOCYTE % |
6.6 % |
|
2.0-7.5 |
EOSINOPHIL % |
0.3 % |
|
0.0-6.0 |
AUTOMATED BASOPHIL % |
1.2 % |
|
0.0-1.7 |
GRANULOCYTE # |
25.7 K/uL |
H |
1.3-7.0 |
MONOCYTE # |
2.0 K/uL |
H |
.1-.5 |
AUTOMATED ABS EOSINOPHIL COUNT |
0.1 K/uL |
|
0.0-0.4 |
BASOPHILE # |
0.3 K/uL |
H |
0.0-0.1 |
LYMPH # |
1.6 K/uL |
|
.8-3.1 |
LYMPHOCYTE % |
5.3 % |
L |
14.7-42.6 |
1. What are the cardiac causes of shortness of breath?
2. How does lung disease affect the heart?
3. Review the admission laboratory results how did these help rule out
the possibility of a pulmonary embolus?
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EKG |
4. What do you see on his EKG?
5. What is your differential diagnosis?
|
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