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70 year old male with shortness of breath

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A 70 year old male was brought to the casualty with c/o of Fever since 6 days Breathlessness since 5 days Productive cough since 5 days History of presenting illness: patient was apparently asymptomatic 6 days back then he developed fever of high grade, intermittent, associated with chills and rigors, relieved with medication. Breathlessness since 5 days which is insidious in onset and gradually progressive to grade 4 since today morning. Productive cough with white mucoid sputum of moderate quantity, non foul smelling, not blood tinged No history of paroxysmal nocturnal dyspnoea,  history of orthopnea present, no history ot decreased urine output, no history of pedal edema, no history of abdominal distension History of chest tightness, back pain No history of vomitings, loose stools, facial puffiness, burning micturition Past history:  Patient is not a known case of htn, dm, asthma, cva, cad Known case of pulmonary tb 5 years back Used ATT 1.5 years back for 6 months History of pleura

Acid base disorders in intensive care unit patients , their comorbidities and outcomes

TITLE: ACID BASE DISORDERS IN INTENSIVE CARE UNIT PATIENTS, THEIR CO-MORBIDITIES AND OUTCOMES INTRODUCTION: The hydrogen-ion concentration is tightly regulated because changes in hydrogen ions alter virtually all protein and membrane functions.(6) The first step in assessment of an acid–base disorder is a careful clinical evaluation. Various signs and symptoms often provide clues regarding the underlying acid–base disorder;  these include the patient's vital signs (which may indicate shock or sepsis), neurologic state (consciousness vs. unconsciousness), signs of infection (e.g., fever), pulmonary status (respiratory rate and presence or absence of Kussmaul respiration, cyanosis, and clubbing of the fingers), and gastrointestinal symptoms (vomiting and diarrhea).  Certain underlying medical conditions such as pregnancy, diabetes, and heart, lung, liver, and kidney disease may also hint at the cause.  The clinician should determine whether the patient has taken any medications that