The Case

CC

Cyanosis

HPI

83yF PMH HTN, HLD p/w fatigue and cyanosis. Reports that all day she has been feeling fatigued and was noted to have a blue color so her son called 911. On arrival she is cyanotic and hypoxic to 80-85% on NRB. Denies fevers, chills, chest pain, shortness of breath, cough, abdominal pain, nausea, vomiting, diarrhea, dysuria, hematuria. Patient denies any toxic ingestions or recent medication changes.

PMH / PSH

PMH: HTN, HLD
PSH: None
Medications: Celebrex, Meloxicam, Cyclosporine 0.05% 1 drop BID, Tolterodine, Pitvastatin, MVI, Omega 3

Physical Exam

VS: 36.6, 90, 122/59, 25 80% on NRB
Gen: NAD
HEENT: NCAT, +periorbital and perioral cyanosis, OP clear, neck supple
Cardiovascular: RRR, no m/r/g
Pulmonary/Chest: Effort normal. No respiratory distress. No w/r/r
Abdominal: Soft, nt/nd, no r/g, normal BS
Extremities: Cyanosis to b/l hands and feet, warm to touch, no edema
Neurological: AAOx3, CN II-XII intact, strength and sensation intact

Labs

ABG: pH 7.484, PC02 32.8, P02 307, HC03 24.3 Lactate 1.8
Troponin: 0.02
WBC: 8.2, Neut 89%, Hgb 10.5, MCV 93.7, Hct 31.1, Plt 218
Na 141, K 4.7, Cl 103, BUN 35, Cr 1.0, Glucose 120, Ca 8.9, AG 12,  
Bili Tot 0.4, Bili conj 0, Alk P 65, AST 18, ALT 22, Alb 3.4, Protein 6.1

CXR: No evidence for acute pulmonary pathology

Questions

  1. What laboratory test will confirm your diagnosis?

  2. What is the treatment?