Test Yourself
Case 5
A 24 year old female with systemic lupus erythematosus was admitted to hospital feeling generally unwell. She has been taking hydroxychloroquin as therapy over the last year as well as metformin and ramipril for T2DM. ABG on admission shows pH 7.1, (7.35-7.45) PaO2 14kPa (11-13kPa) bicarb 11 (22-24mM) pCO2 2.0 (4.7-6kPa).
Her ECG is shown below:
Q1) What do the blood gas results show (1 mark)
Q2) Given the clinical picture what other blood test is the most important (1 mark)
Q3) Please describe the ECG systematically (7 marks)
Q4) Suggest the most likely cause for these ECG abnormalities (1 mark)
Q5) What initial treatment would you administer for this patient (4 marks)
Q6) In addition to the initial management what definitive management may likely be required in this case (1 mark)
Q7) Name another 2 cardiac complications of SLE (2 marks)
Answers
Q1) metabolic acidosis (1 mark)
Q2) Urea and Electrolytes to check K+ formally as well as to check for renal failure and uraemia (1 mark)
Q3) ARI-BAR approach, A- electrical activity in all leads (1 mark), R- rate approximately 100bpm (1 mark), I - regular rhythm (1 mark), B - broad QRS complexes (1 mark), A - P waves absent (1 mark), R - 0:1 P:QRS ratio, Interval lengths , left axis deviation (1 mark), Slurred ST segments (1 mark) Max 7 marks
Q4) renal failure secondary to SLE and pharmacotherapy (1 mark)
Q5) IV fluids (1 mark), IV calcium carbonate/g;uconate (1 mark), Insulin/dextrose infusion (1 mark), nebuliser salbutamol (1 mark), stop the offending drugs (1 mark)
Q6) Renal replacement therapy - either dialysis or renal transplant (1 mark)
Q7) heart block (1 mark), valve problems (1 mark), pericarditis (1 mark) Max 2 marks
