A case report of a COPD patient presented in severe metabolic alkalosis

Authors

  • Ashish Shrestha Department of pulmonary, critical care and sleep medicine, Nepal Mediciti Hospital
  • Naresh Gurung Department of pulmonary, critical care and sleep medicine, Nepal Mediciti Hospital
  • Ashish Karthak Department of pulmonary, critical care and sleep medicine, Nepal Mediciti Hospital
  • Sanjeet Bhattarai Department of pulmonary, critical care and sleep medicine, Nepal Mediciti Hospital
  • Rakesh Lama Department of pulmonary, critical care and sleep medicine, Nepal Mediciti Hospital
  • Utsav Kumar Shrestha Department of pulmonary, critical care and sleep medicine, Nepal Mediciti Hospital
  • Kishor Khanal Department of critical care, Nepal Mediciti Hospital
  • Anup Ghimire Department of critical care, Nepal Mediciti Hospital
  • Ashim Regmi Department of critical care, Nepal Mediciti Hospital
  • Sanjeet Krishna Shrestha Department of pulmonary, critical care and sleep medicine, Nepal Mediciti Hospital

DOI:

https://doi.org/10.3126/nrj.v1i2.54936

Keywords:

Chronic Obstructive Pulmonary Disease, Respiratory Failure, Non Invasive ventilation, Metabolic Alkalosis

Abstract

Chronic Obstructive Pulmonary Disease (COPD) patients generally present with respiratory acidosis and type 2 respiratory failure. Here we present a case of 65 years old female, who is a known case of COPD and presented in our emergency department with severe metabolic alkalosis (pH 7.730, HCO3- greater than 99.9mmol/l). She was referred from other center after the development of seizure. Urinary sodium was sent which indicated the cause of metabolic alkalosis was contraction alkalosis; we then treated the patient with IV fluids, antibiotics and Mechanical Ventilator. Arterial Blood gas analysis was initially done every 4 hours till the pH was corrected. After pH was corrected the patient was extubated to intermitted Non Invasive Ventilation (NIV) for type 2 respiratory failure. With pulmonary rehabilitation we could discharge the patient with inhalers; without the need for NIV or supplementary oxygen. This is one of the rare cases where the patient presented with a very high bicarbonate level, high partial pressure of carbon dioxide in arterial blood, and high pH. The patient was successfully managed with IV fluids and mechanical ventilation.

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Published

2022-12-31

How to Cite

Shrestha, A., Gurung, N., Karthak, A., Bhattarai, S., Lama, R., Shrestha, U. K., Khanal, K., Ghimire, A., Regmi, A., & Shrestha, S. K. (2022). A case report of a COPD patient presented in severe metabolic alkalosis. Nepalese Respiratory Journal, 1(2), 34–37. https://doi.org/10.3126/nrj.v1i2.54936

Issue

Section

Case Reports