A 28 year old female presents to your Emergency Department with palpitations and shortness of breath. She has no chest pain and no significant past medical history.
On examination she is dyspnoeic with clear lung fields and good air entry bilaterally. She has a normal CXR.
Vitals:
BP 120/60
PR 220/min SVT, which reverts to a sinus rate of 110/min after Valsalva
RR 25
T 36.7 degrees celcius
Sats 84% on 15 litres non rebreather
Her Arterial gas:
pH 7.46 (7.36-7.44)
pCO2 27 (35-45 mmHg)
pO2 49mmHg
HCO3 19 (24 +/-2 mmol/l)
Hb 194 (115-135 g/l)
Na 143 (137-145 mmol/l)
K 3.7 (3.3 – 5 mmol/l)
Cl 115 (99-111 mmol/l)
Questions
1. Describe the abnormalities
2. Interpret the findings
3. What is the most important investigation?
Thanks to Shai for this great case
Type 1 Respiratory failure / respiratory alkalosis/ High A- a Gradient
Possible PE – Hypoxia / Tachycardia with clear chest
CTPA
Hb 194— Polycythemia ? Chronic hypoxia
Hi Karthik,
Why the chronic hypoxia (in a 29 year old) with an acute event like a PE?
Agree. Its not clear as to the duration of the symptoms and I am not sure of the reason for the polycythemia.
What are the other differentials you might consider in this patient?
Hi guys,
This was my patient. I followed her up when she was admitted to CCU. She has a large ASD with Eisenmenger’s, and was referred for ASD closure.