Question

Question-Mini-Case:

On a routine exam, an apparent 58-yr old Caucasian male states that he has been extremely fatigued following any type of activity, having a constant “pounding headache,” pain in his joints and along “his side” (points to the abdominopelvic region near his spleen). He has recently arrived to the area (elevation of 5,500 feet) for vacation, from the coast (elevation 10 feet). During his examination you obtain the following measures:

Blood Pressure: 146/100 mm Hg;

Pulse rate: 95 beats/min;

Respiration rate: 18 breath/min;

Heart Sounds: systolic murmur;

Lung sounds: Slight Rail;

ECG: No deviation;

CBC: Hct: 57%; Erythrocyte: 5.1x106 cells/μL; Leukocytes: 4,000 cells/μL; Hb: 15 g/dL; pO2: 85 mm Hg; saO2: 80%; pCO2: 28 mm Hg; [HCO3-]: 28 mM; pH: 7.25; EPO: 30 mU/mL.

You decide that a treatment of bicarbonate (pushed via saline) and supplemental oxygen (100%). After 60-minutes of treatment, his pO2 rises to 97 mmHg and saO2 to 95% with normalization of pCO2 and [HCO3-].

In a well-formulated response, and using correct medical/scientific terminology, generate a presentation of this case include in your response:

The possible etiology (reason/rationale) for the occurrence of the abnormal findings and any possible innate underlying issues that you must advise the male about. What other test is necessary?

Indicate the physiological responses that are the possible reason for the responses seen to treatment and what long-term treatment might be required for this issue.

Add feedback loop to the answer.

Answer 1

CASE PRESENTATION

A 58 yr old male pateint was presented with cheif complaints of extreme fatigue following any type of activity, constant ponding headache, paint in joints and at the abdominopelvic region near spleen.

Travel history- he ahs recently arrived to the area (elevation of 5,500 feet) from the coast (elevation of 10 feet)

o/e:

Blood pressure - 146/100 mmHg

Pulse rate -95 beats/min

Respiratory rate : 18 breath/min

Heart sounds : systolic murmur

Lung sounds :. Slight rail

ECG : normal

Observation-

His BP is raised.

Pulse rate and respiratory rate are normal.

Systolic murmur represent prolapse of mitral valve, tricuspid valve and papillary muscle dysfunction.

Lab investigation

Complete blood picture

Hct: 57% (slightly high)

Erythrocytes: 5.1 × 106 cells (normal)

Leukocytes: 4000 ( slightly low)

Hb: 15 (normal)

pO2 85 (normal)

saO2 : 80% (low)

Pco2 : 28mm (low)

Hco3 : 28mM ( normal)

Assessment : based on the subjective and objective evidence the patient is diagnosed to have hypoventilation/ hypocapnea.

Treatment:

1) Bicarbonate pushed through saline

2) oxygen supplement 100%

Observation- pO2 raised to 97mmHg and saO2 95%. The pCO2 and HCO3 are normal.

Report: pateint is recovering from the hypoventilation and hypocapnea.

The etiology for the occurance of the abdominal pain may be due to underlying enlargement of the spleen(splenomegaly) I suspect this beacuse of the decrease in the WBC count. This decrease will occur when the enlarged spleen traps the WBC and destroy them. For further diagnosis we can suggest a abdominal ultrasound scan to observe the enlarged spleen. Along with and MRI to acess the blood flow to the spleen.