Give me possible diagnoses? Explanation of pathophysiology of each of the differ

Question

Give me possible diagnoses? Explanation of pathophysiology of each of the differential diagnoses? Suggestion of what exra laboratory/ diagnostic tests needed to come to a more definite diagnosis for this patient? 1. Mr. Smith is a 52-year-old widow. He is retired and living alone. He enters the emergency department complaining of chest pain, shortness of breath and tingling in fingers. His breathing is shallow and rapid. He denies history of diabetes; and his blood sugar test done on the spot shows normal result. He has no significant respiratory or cardiac history. He takes several antianxiety medications. He says he has had anxiety attacks before. He is working as a manager in busy department store. He is single with no children. His family history is unremarkable, except his maternal grandmother died because of breast cancer at the age of 60 years old. o ABG results are: pH- 7.48 PaC02-28 mmHg (normal: 38-42 mmHg) HCO3-22 mEq/L (normal: 22-28 mEq/L) . Pa02 85 mmHg (normal 75-100 mmHg) Physical exam: A middle age, non-obese male, looks distressed. Respiratory rate: 12 breaths per minute (normal 12-20 x/minute) o o o Blood pressure: 100/80 mmHg (normal: 120/80 mmHg) Heart rate: 105 beats per minute (normal 60-100 x/minute o o Lung: clear to auscultation. o Temperature: 37°C. (normal: 36.10-37.20)

Explanation / Answer

pH is slightly higher than the normal.

PaCO2 is low. HCO3 levels are the normal boundary levels. PaO2 is within the normal limits.

The scenario is completely ucompensated respiratory (since pH is high and CO2 is low) alkalosis. Respiratory rate is higher than the normal, that is, hyperventilating to increase oxygenration, and is trying to blow of CO2.

Since the person is hyperventilating from anxiety attack, he should be allowed to breathe into a paper bag. This allows rebreathing of exhaled CO2 and increases PaCO2.

Additional diagnosis is to be made to confirm if the patient has COPD. Such patients do not respond to paper bag breathing, and develop hypoxic drive.

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