On Respiratory Infections: A case discussion (PART 2)
January 24th 2012 09:12
At this point, we would like to comment on the use of chest x-ray in diagnosing respiratory problems. We have to be reminded that x-ray is just an adjunct to our diagnosis. Diagnosis of most of the respiratory problems is clinical. Some of indications of chest x-ray include: determination of pathogens causing the disease (streaky infiltrates point to viral infection), or ruling in tuberculosis, and others.
The more common causes of acute upper respiratory tract infection are viruses. Ideally, antimicrobial drugs are delayed and supportive management is preferred, like increase in oral fluid intake, advising patient to rest, and administration of mucolytics and/or decongestants. In our case however CBC can aid in ruling in bacterial causes. Once ascertained, antimicrobial therapy is started. Among the drugs used empirically are amoxicillin, co-amoxiclav, and second generation cephalosporins. Patient was started on Cefuroxime, a second generation cephalosporin.
The focus of main concern however is not on her respiratory symptoms. Rather it is on her co-morbidities: diabetes mellitus and hypertension. Upon physical examination, BP ranged from 140-180/80-90 mmHg. CBG is also elevated at 135 mg/dL. HbA1c is elevated as well. These circumstances have been the reason for admission.
In this setting, we expect poor recovery and invasion of opportunistic microorganisms. The concern therefore is to control blood sugar and hypertension. In her case, Metformin and Glibenolamide were used. Angiotensin receptor blockers like losartan and telmisartan are the drug of choice for hypertension, since they provide less drug interaction and adverse effects.
The focus of main concern however is not on her respiratory symptoms. Rather it is on her co-morbidities: diabetes mellitus and hypertension. Upon physical examination, BP ranged from 140-180/80-90 mmHg. CBG is also elevated at 135 mg/dL. HbA1c is elevated as well. These circumstances have been the reason for admission.
In this setting, we expect poor recovery and invasion of opportunistic microorganisms. The concern therefore is to control blood sugar and hypertension. In her case, Metformin and Glibenolamide were used. Angiotensin receptor blockers like losartan and telmisartan are the drug of choice for hypertension, since they provide less drug interaction and adverse effects.
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