2. Diagnosis Case ( 19 hours)

Pagana: Mosby’s Manual of Diagnostic and Laboratory Tests, 5th Edition

Pneumonia Case Studies

A 73-year-old white male has been experiencing shortness of breath and left-sided chest pain for the last 24 hours. More recently, he has noted shaking chills and a fever. About 3 days before, he had been drinking alcohol excessively and passed out. When he awoke, he noted vomitus on his shirt. He does have a history of hypertension and coronary artery disease.

His physical examination indicated that he was tachypneic and had a fever. His heart rate was 110 per minute. His chest examination demonstrated rhonchi in the lower lateral left chest.

Studies	Results
Routine laboratory work	Normal except for elevated WBC equal 18,000 with 88% neutrophils
Chest X-ray study, p. 1014	Pulmonary opacity in the left lower lung field.
Arterial blood gasses (ABGs), p. 109
pH	7.39 (normal: 7.35-7.45)
Pco2	36 mm Hg (normal: 35-45 mm Hg)
Po2	79 mm Hg (normal: 80-100 mm Hg)
HCO3	23 mEq/L (normal: 22-26 mEq/L)
B-type natriuretic peptide (BNP), p. 367	78 pg/mL (normal: <100)
EKG, p. 544	No evidence of ischemic disease
Blood cultures, p. 708	Positive for Klebsiella
Sputum culture, p. 761	Positive for Klebsiella
AST, ALT, LDH, alk phos, p. 47	All mildly elevated liver enzymes