CO2duringHD - Acid/Base Conference 11/3/09 Saleem Bharmal...

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Unformatted text preview: Acid/Base Conference 11/3/09 Saleem Bharmal Case HPI: 43 y/o AAF with PMHx of SLE, ESRD from lupus nephritis on HD, interstitial lung disease on 4L home O2 at baseline who was admitted for confusion and hypercapnic respiratory failure after several days of increased cough and SOB. On day of admission patient went to her scheduled outpatient dialysis where she states she felt sick She completed dialysis but no ultrafiltration was removed. She was sent to the ED from dialysis and was found be confused and have a PaCO2 in the 120s. She was started on non-invasive ventilation with improvement of mental status and admitted to the ICU. PMHX: SLE ESRD from lupus nephritis, kidney transplant 2002 s/p rejection in 2004 Interstitial lung disease felt secondary to both lupus and several round of Cytoxan to treat her lupus History of LGIB; partial bowel resection for bleeding AVM Case Outpt Meds: Plaquenil, Renagel, Ferrous Sulfate, VitD Admission Physical Exam: T 99 BP 110/70 P 100 RR 26 O2Sat 100% bipap 20/5 60% FiO2 Pt is noted to be obese, comfortable on Bipap. No JVD. Lungs noted to have dry crackles up lung fields bilaterally. Tachycardic, regular with 2/6 murmur at LUSB. AVF on right arm with no edema in the extremities. Admission Labs: WBC 8.8 /Hgb 12.7 / Hct 44.8 / plts 171 Na 140 / K 3.4 / Cl 99 / HCO3 34 / BUN 13 / Cre 4.1 / gluc 92 / Ca 8.7 CXR: Lung inspiratory volume is low. Known background of pulmonary fibrosis. Superimposed infectious process of pulmonary venous congestion in not excluded Case...
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CO2duringHD - Acid/Base Conference 11/3/09 Saleem Bharmal...

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