A 73-year-old white male has been experiencing shortness of breath and left-sided chest pain for the last 24 hours.

Pagana: Mosby’s Manual of Diagnostic and Laboratory Tests, 5th Edition
Pneumonia Case Studies
A 73-year-old white male has been experiencing shortness of breath and left-sided chest pain for the last 24 hours. More recently, he has noted shaking chills and a fever. About 3 days before, he had been drinking alcohol excessively and passed out. When he awoke, he noted vomitus on his shirt. He does have a history of hypertension and coronary artery disease.

His physical examination indicated that he was tachypneic and had a fever. His heart rate was 110 per minute. His chest examination demonstrated rhonchi in the lower lateral left chest.

Studies

Results

Routine laboratory work

Normal except for elevated WBC equal

18,000 with 88% neutrophils

Chest X-ray study, p. 1014

Pulmonary opacity in the left lower lung field.

Arterial blood gasses (ABGs), p. 109

pH

7.39 (normal: 7.35-7.45)

Pco2

36 mm Hg (normal: 35-45 mm Hg)

Po2

79 mm Hg (normal: 80-100 mm Hg)

HCO3

23 mEq/L (normal: 22-26 mEq/L)

B-type natriuretic peptide (BNP), p. 367

78 pg/mL (normal: <100) EKG, p. 544 No evidence of ischemic disease Blood cultures, p. 708 Positive for Klebsiella Sputum culture, p. 761 Positive for Klebsiella AST, ALT, LDH, alk phos, p. 47 All mildly elevated liver enzymes