Lab Case 58 – Interpretation

A young obese woman with asthma prsents with tachypnoea, tachycardia and a low grade temperature (on antibiotics)

1.

Acute compensated respiratory alkalosis

Additional high anion gap (35.5)

mild hypokalaemia

elevated lactate

2.

Hyperventilation causing respiratory alkolosis and hpokalaemia (shift), indicates some respiratory reserve

Lactic acidosis due to salbutamol, dehydration, sepsis

3. Poor prognostic factors:

older age

chronic severe asthma

high values for inflammatory laboratory markers – ESR/CRP

asthma exacerbated by pneumonia – radiologically proven

relatively low nutritional status – low albumin

Features of severe asthma:

Near fatal asthma – Raised Paco2 and/or requiring mechanical ventilation with raised inflation pressures

Life-threatening asthma

Any one of the following in a patient with severe asthma:

PEF <33% best or predicted

SpO2 < 92%

PaO2 < 60 mmHg

Normal PaCO2 35-45 mmHg

Silent chest

Cyanosis

Feeble respiratory effort

Bradycardia

Dysrrhythmia

hypotension

exhaustion

confusion

coma

Acute severe asthma

Any one of:

PEF 33–50% best or predicted

RR > 25/min

HR > 110/min

Inability to complete sentences in 1 breath

4. Disposition Factors

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