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Mr. Joseph Hope is a 56-year-old self-employed communications consultant. He has smoked a pack/day for 30+ years. He has a 10-year history of asthma/chronic bronchitis, arthritis of the knees and congestive heart failure. He is 6′ tall and weighs 350 lbs. He routinely takes a diuretic (furosemide) and his pulmonary medications. The following laboratory values are obtained:

Diagnosis:

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COPD exacerbation secondary to bronchitis, right CHF, degenerative osteoarthritis, duodenal ulcer
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COPD exacerbation secondary to bronchitis, right CHF, degenerative osteoarthritis, duodenal ulcer

Presenting signs and symptoms:

Cough productive of brownish-green phlegm, ankle swelling, orthopnea (six pillows), dyspnea (on walking one block), fever and chills, and tinnitus

Relevant lab values (assume all other lab values are normal):

Na =136, K= 3.8, glucose = 99, BUN = 19, Creatinine = 1.1, WBC = 5,600, Theophylline level = 5.7 ug/ml, Salicylate level = 32 mg/dl.

ABGs on room air: pH = 7.32, pCO2 = 57, pO2 = 57, HCO3= 30, O2 saturation = 81%.

Relevant diagnostic tests:

Chest x-ray- borderline cardiomegaly, chronic bronchitis with bibasilar pneumonia.

ECG – sinus tachycardia. PFTs – FVC = 3.08 (predicted 5.24), FEV1 = 2.00 (predicted 3.86); UGI/Small bowel series depicts an ulceration in the duodenal wall.

In your review of this case, please address the following questions. Please include at least 5 research articles and /or Web citations as references.

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