Question

CASE STUDY:

A 55-year-old male presents to his primary care physician's office with cough, mild dyspnea, and fever to 101 degrees. Symptoms have been present for the past 3 days, and when over-the-counter cold medications were having no effect, he decided to seek medical attention. On initial examination, blood pressure was 120/73, pulse was 96 and regular, and respirations were 20. He was febrile with a temperature of 100.9 degrees. Lung examination revealed the presence of right lower lung crackles with decreased breath sounds in this area as well. Laboratory studies revealed WBC of 15.6 with a left shift, sodium of 140, potassium of 4.5, BUN of 22 and creatinine of 1.0. Chest x-ray revealed a right lower lobe infiltrate. Based upon the above presentation, what is the most appropriate course of action?

Answer 1

A 55 year old male with cough, dyspnoea, fever, crackles And Decreased breath sounds in right lower lobe of lungs as well as chest xray showing right lower lobe infiltrate all point to pneumonia ​​​​​​(bacterial)

However, it is seen that the BUN level is less than 30 and sodium is more than 130 hence the pneumonia is not very severe.

(in severe pneumonia BUN >30 and Sodium <130 (hyponatremia))

The suggested course of action would be

• Start the patient on emperical antibiotic treatment - oral amoxicillin/ iv benzyl penicillin With Or without oral doxycycline
• Gram staining And Culture for sputum is To be done
• Blood culture is also. Indicated
• Bronchoalveolar lavage may be done and specimen Sent for Culture
• Once the organism is identified and susceptible antibiotics recognized, the antibiotic therapy is modified accordingly
• Oxygen may be given if dyspnoea worsens