Clinical Pearls in Respiratory Diseases

Abstract

In this section, the authors present some common and some uncommon respiratory cases that have diagnostic and/or therapeutic challenges. First case is of an eight- yr- old child having Acute onset Wheeze and fever, second one is of a 1.5- yr- old Wheezing child not responding to inhaled bronchodilators and corticosteroids, third of a 4-yr- old with Respiratory distress and wheezing with underlying ventricular septal defect, and fourth of a 5-yr- old with fever for 1 month, epistaxis from right nostril for 15 days, polyuria for 10 days, impaired consciousness and discoloration of right orbit. Each one had some unique pointers to correct diagnosis and management. The authors share clinical learning points from these cases with a concise review of the topic.

Effects of diabetic ketoacidosis in the respiratory system

“…Once patients with DKA develop Kussmaul’s respiration, they are reaching the point of respiratory muscles fatigue, and mechanical ventilation should be considered[34,38-40]. Furthermore, patients in DKA are severely “air hungry” prior to intubation, and are at higher risk to develop acute respiratory distress syndrome (ARDS)[3,41] due to hyperpnea.…”

Approach to a Child with Lower Airway Obstruction and Bronchiolitis

“…& In a child with acute onset wheezing, with history of preceding fever and abdominal pain, and presence of temperature >38°C at presentation, pneumonia is the likely diagnosis [4]. & All infants/children with bilateral wheezing do not have bronchial asthma [4] & Foreign body aspiration can present with nonlateralization of findings; it should be suspected in nonresponders to inhaled bronchodilators and corticosteroids [4].…”

“…& All infants/children with bilateral wheezing do not have bronchial asthma [4] & Foreign body aspiration can present with nonlateralization of findings; it should be suspected in nonresponders to inhaled bronchodilators and corticosteroids [4]. & Asthma and congenital heart disease can coexist [4]. & In a young infant (2 to 6 months) with mild to moderate grade fever and wheeze along with respiratory distress, bronchiolitis is the most likely diagnosis.…”