Respiratory disease
Case 11: A Patient with Headache and Worsening Breathlessness
CASE
A 67‐year‐old woman presents with a history of morning headache and worsening breathlessness over a period of several months. She is sleepy during the day and has had a recent chest infection. She is an ex‐smoker with a 30 pack year history. She has recently been started on inhaled bronchodilators with little benefit. She has a history of congenital scoliosis with partial corrective surgery in childhood.
On examination she has a marked scoliosis, basal crackles on the right and is cyanosed and drowsy. Blood gas analysis on air reveals:
pH 7.32 PO2 7.4 kPa PCO2 8.2 kPa Base excess 8 HCO3− 32 mmol/L
QUESTION 1
Your score this session: 0 of 0
What is the likely cause of the blood gas abnormality?