Case Study of Aspiration Pneumonia

Shortness of breath can be cause by several reasons or conditions, other tests used to diagnose SOB: Blood O2 saturation, Hemoglobin level and Erythrocyte count to rule out anemia, CT scan of the chest, Lung Perfusion Test for the diagnose of Pulmonary embolism along with D-dimer blood test, NT-proBNP to rule out CHF. All the conditions mentioned above can produce SOB in a patient. Also, obese patients present SOB due to displacement of the diaphragm and pressure over the thoracic muscles, pregnant women specially after second trimester present SOB due to cardiac overwork and increase on hormones production.

Unfraternally some strains of Klebsiella pneumoniae are resistant to most antibiotics. A common practice for the treatment of pneumonia cause by Klebsiella is to use broad-spectrum antimicrobial agents as initial empiric treatment with third-generation cephalosporins or quinolones provide coverage for community-acquired infection. This ensure better outcomes and reduce morbidity and mortality (EH, et al. 2000).

Due to resistance to carbapenems culture and sensitivity should be perform and patient keep on isolation and treated with broad-spectrum antibiotics until antibiogram results are obtained. Ceftazidime/avibactam is also active against carbapenem-resistant Enterobacteriaceae that produce K pneumoniaecarbapenemases (van Duin, 2015).

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From the history obtained and patients LFT labs results, this patient has an alcoholic hepatitis due to alcohol abuse problems which creates a challenge in the design of plan of care for this patient and adherence to medication regimen. Social problems include work stability and family roles, this patient should be referring to a social worker before discharge to address home treatment and follow ups appointments.

Reference:

van Duin, David. A, Robert. Bonomo Issue 2, 15 July 2016. Ceftazidime/Avibactam and Ceftolozane/Tazobactam: Second-generation β-Lactam/β-Lactamase Inhibitor Combinations.Clinical Infectious Diseases, Volume 63, Pages 234–236

EH Ibrahim, Sherman G, Ward S, Fraser VJ, Kollef MH. The influence of inadequate antimicrobial treatment of bloodstream infections on patient outcomes in the ICU setting. Chest. 2000;118(1):146-155.

Addison's Disease Case Studies

As we saw in the case study, several test can be performed to diagnose and confirm Addison’s disease. Cortisol level been the most simple and accurate way to diagnose Addison’s disease. Some authors or institutions refers to ACTH stimulation test as the preferred method for the diagnosed of this disease (Griffing, 2018) but other authors say that this test is to specific and it should be performed by endocrinologist. Addison’s disease is characterized by the decrease or absence or low production of adrenocortical hormones (Bornstein, 2016). In order to confirm the diagnosed, along symptoms presented and clinical evaluation, an ACTH stimulation test is performed, specific radiology test like CT scan of abdomen or MRI test to assess adrenal gland hypotrophy or presence, adrenal antibodies test, insulin tolerance test, thyroid function test (Griffing, 2018).

All the test mentioned above are test used for the diagnosed and confirmation of Addison’s disease, to differentiate between primary and secondary it is a little bit more complex than a regular blood test. Causes of primary Addison’s disease are due to direct damage to de adrenal gland, this may be from and autoimmune disease, hence where positive adrenal antibodies are found will be a confirmation of primary Addison’s disease. High levels of ACTH and low levels of cortisol are also findings on primary Addison’s disease. Secondary, will be due to damage at the level of the pituitary gland or hypothalamic, ACTH will be low or absent, and adrenal gland will disappear or become atrophy due to lack of stimulation, this can be confirmed by CT or MRI of the abdomen.

As we can see Addison’s disease occurs due to decreasing or ceasing production of adrenocortical hormones, been one of this hormone’s aldosterone. Aldosterone acts on the kidneys promoting sodium absorption and potassium secretion, since aldosterone level will be low them sodium will be depleted, and potassium will be high. High potassium level can also be confirmed by EKG.

Reference:

1. Bornstein SR, Allolio B, Arlt W, et al. 2016. Diagnosis and treatment of primary adrenal insufficiency: An Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2016 Feb;101(2):364-89.
2. George T Griffing, (2018) Addison Disease Workup. Medscape. Addison’s disease: practice essentials, epidemiology. https//emedicine.medscape.com/article/116467-overview

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