MedBugs: SAQ #390

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Case: Obesity hypoventilation syndrome

A 44-year-old Polynesian woman presents with a 4-day history of progressive dyspnoea and somnolence. She has a BMI greater than 50, loud snoring and reduced conscious state. Obs are as follows : T 37.1 ; HR 80 ; BP 140/90 ; RR 24 ; Sats 84% RA Air entry is reduced bilaterally with widespread soft polyphonic wheeze and you note pitting oedema to her hips. Her ABG is as follows : FiO2 0.28 pH 7.20 pCO2 96 pO2 70 SaO2 93% HCO3 38 Hb 186

1. Perform two relevant calculations on the ABG and comment on their clinical significance. 4 marks

2. What is the most likely cause for this presentation? 1 mark

3. List three differential diagnoses for this presentation. 3 marks

4. List your immediate steps in managing this patient. 4 marks

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Case: Obesity hypoventilation syndrome

1. Perform two relevant calculations on the ABG and comment on their clinical significance. 4 marks

2. What is the most likely cause for this presentation? 1 mark

3. List three differential diagnoses for this presentation. 3 marks

4. List your immediate steps in managing this patient. 4 marks

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