68/F

68 year old female resident of vemulapalli housewife 
Was brought to casualty with complaints of shortness of breath since 10days
Decreased appetite and weakness since 4 days
Decreased activity since 4 days

Patient was apparently asymptomatic
 5 years back--> then she developed sob and was taken to private hospital , was given Nebulisation (?unknown medication) relevied symptomatically
Sob + seasonal variation ( every year during winters)

6months back-->Patient developed similar complaints with fever and was admitted in pvt hospital was treated as Bronchial asthma with Nebulisation 

10days back --> 
Sob- insidious onset gradually progressed from grade 3 (mmrc)
Fever+ cough + wheeze-
Not a/w chestpain , cold, Palpitations, sweating
No h/o orthopnea , pnd 
Wad given Nebulisation 5 days back which could relieve her symptoms temporarily 
Cough - Non productive 

3-4 days back--> patient developed increased sob (grade 3-4), weakness , increased fatigue, hypomentation , decreased appetite, unable to move from bed , or walk without support 

Today morning-->
Was taken to miryalguda hospital- with increase in severity of sob and weakness 
and hypomentation
Was investigated and referred to our hospital 


Past- 
10 years back patient had history of fall (head injury) ( not a/w loc,projectile vomiting , seizure, weakness)
Ct brain done - r/o hmge
Was diagnosed with htn and was started on telma h 40/12.5

4 years back- patient diagnosed with hypothyroidism (using thyronorm)

Biomass fuel exposure+

N/k/c/o Dm, CAD, tb ,epilepsy 


Vitals - at time of presentation
Pt - tachepnic
Gcs- E4V5M5
Bp- 110/70 mm Hg
Sat- 89 on RA --> 96 on 2lts O2
Grbs-141 mg /dl
Pr- 120 bpm , irregular
Ausc- 
BAE+ ,
Crepts+ at IAA, ISA
rhochi + at ISA, IAA, ICA

Ecg - sinus rythm , irregular, vpcs+, ?MAT

Labs- 
Hb- 10.1
Tlc- 18.5K
Plt- 3.32lks

Na- 123(dec)
K- 3.3(dec)
Cl- 82 

Serum osm- 254(hypotonic)

Urinary Na- 125
K-26.9
Cl-149

Abg-
Ph- 7.54
PCo2- 27.8
PO2- 61.6
SpO2- 93.5
Hco3- 26.3(st) 23.8(c)
( respiratory alkalosis)



Prov diagnosis-- 
Acute exacerbation of asthma with
? Bronchiectasis
With Hyponatremia, hypokalemia under evaluation 
Known Htn , hypothyroidism

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