33 week amenorrhea with sudden onset of severe breathlessness , EF 40,%, myocarditis , no CAD , no history of any comorbidity , BP 130/90, Pulse 120 , Respiratory rate 40 , gasping , intubated and shifted to icu On vent. please interpret the ABG. how to proceed

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metabolic acidosis fully uncompensated with normal anion gap.

kindly look for renal cause

ECG of patient enclosed.please describe the ECG

P pulmonale

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As haemoglobin is low It is possible to have this picture

Metabolic acidosis with electrolytes abnormal

Cardiomyopathy of idiopathic origin could be a cause, management essentially to increase ionotropic action of the heart and correction of electrolyte imbalance, support respiration and acid base imbalance, termination of pregnancy could emerge as emergency when patient does not respond to ICUsupport.

Bedside 2d echo chestxray will help out

Uncompensated Non anion gap Metabolic acidosis. Either renal tubular acidosis due to ischemic damage to tubules but pottasium is usually low in that case and diarrhoea causing bicarb loss. Not able to compensate due to poor diaphragmatic movement due to third trimester pregnancy, obesity or altered sensorium may be will have to find the cause. ECG- sinus tachycardia P pulmonale Diffuse ST-T depression ( ant+inferior+lateral leads) aVR st elevation Left main coronary occulusion or Diffuse subendocardial ischemia or as you have already mentioned Myocarditis Hyponatremia - fluid retention in pregnancy or systolic dysfunction left ventricle Hyperkalemia- Metabolic acidosis reducing pottasium secretion

ABG suggestive of Metabolic acidosis with respiratory alkalosis She mite a case of peripartum cardiomyopathy. Required extensive ICU management and immediately delivery. Ventilator support to be continued Chance of perinatal morbidity r high

Metabolic acidosis Respiratory acidosis Hyponatremia Hypocalcemia Hyperkamemia Lactate raised Lactic acidosis Hyperoxia may be fio2,raised

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