A 62 years k/c DMT2 old chronic bidi smoker male patient admitted with c/o diffiulty in breating , cough,coryza since last 2 days. Also having sever constipation since past 5 days. o/e BP 110/70, PR-78,RR-20 SPO2-92% ON R.A LUNGS- left side AE decreased with B/l fine corse crepts rest systems are WNL LAB INV'N serum K level 2.0 rest CBC & Biochen was WNL 2 DAY OF ADMKSSÌON PATIENT DEVELOPED HORSENESS OF VOICE further s.electrolyte shows K level 1.7 ENT specilest opinion taken S/O partial left vocal cord palsy and advice oral steroids . K suplimented but horseness does not improved . so what next ????



correction of hypokalemia improve it start nebulisation with budocort iv antibiotic it may be exacerbation of copd

do HRCT rule out Ca Lung

do HRCT and rule out lung cancer

ECG changes suggestive of hypokalemia..T wave inversion present in diffuse leads..K+ correction with Inj Kcl infusion ..rpt K+ daily..k+ rich diet..

as i mentioned k+ had been sufficiently replaced

ask for whether pt is on diuretics..

no he was not on diurtcs

pt is in bronchodilator?

no , brochodil has been stoped

ta medrol 4mg. .nebuliz. .liq. spa racid .correct .k it takes little time

Look for rec.laryngeal nerve palsy due to chest condition..

Left hilar lymphnodes are enlarged...look for..?Ca lung. ECG shows st depression in almost all leads..persistance of S in V5, 6 ...global Ihd with Rvh

yes sir we had ct chest which showss compressive lt lung mass congrts!!!!

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left hilar lymphnodes enlarged ?Koch's or ca lungs..also pt is DM type 2 if he is on insulin thn further K decrease..coz steroids used for breathlessness and for control on insulin...correction K with kcl infusion..and daily check up K. .go for HRCT chest...to rule out ca lungs or Koch's...

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