Case Eight Diagnosis


PW is an 85-year-old male transported to the ED via private ambulance from an area nursing home because of sudden onset shortness of breath and fever. He has a long history of COPD and dementia of the Alzheimer type. Physical examination reveals an elderly male who appears thin and cachectic. Respiratory rate 32 and slightly labored, temperature 101.2o F, SpO2 (on room air) 85%. He has a frequent loose nonproductive cough. Skin is dry to the touch with decreased turgor.
The patient is placed on a nasal cannula at 3 Lpm and arterial blood is obtained for analysis after 30 minutes with the following data:
pH 7.48; PaO2 64:
PaCO2 31; SaO2 93%:
HCO3 24; Hgb 13.1:

Besides pneumonia, which of the following secondary conditions is this patient most likely experiencing?

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