Knee Pain and Respiratory Distress

A combination of symptoms result in a surprising diagnosis.

By Marven Ewen, MD
Medical Director

Imagine you are seeing an elderly patient who says he feels weak and appears short of breath. He has a rapid breathing rate and increased effort. He says he just gradually started not feeling well throughout the day. He denies any chest pain or cough. There is no history of COPD or other respiratory problems.

 

He denies taking any prescribed medications and has no allergies. There have been no changes in his life recently except he had started taking some aspirin for chronic arthritic pain in his knees which had been getting worse over the past few weeks. 

 

His vital signs are within normal limits except for a respiratory rate of 28 and quality is deep and labored. O₂ saturation on room air is 100%.

 

His chest is clear and there is no edema.

 

So you ask yourself, What’s going on? Why is he breathing so fast when he doesn’t seem to have any other cardiorespiratory signs or symptoms? Are you feeling confused?

 

What makes us breathe? Chemoreceptors in the body recognize elevated CO₂ levels and make the respiratory system work harder to blow off this CO₂. Elevated CO₂ levels are associated with acidosis, which is damaging to the cells of the body. If untreated, it can lead to organ failure and death.

 

So this patient actually presented with Kussmaul breathing. Named after German physician Adolf Kussmaul (1822-1902), it is a pattern of deep, labored breathing associated with metabolic acidosis. In fact, you can use Dr. Kussmaul’s name (minus the u) as an acronym to remember the causes of metabolic acidosis. These are: Ketones (diabetic ketoacidosis), Uremia (kidney failure), Sepsis, Salicylates, Methanol, Aldehyde and Lactic acidosis.

 

I asked the patient for some clarification about how much aspirin he had been taking. Turns out it was a lot, especially for a 72-year-old man. He had been taking around sixteen 325mg tablets per day over the previous couple of weeks.

 

Aspirin overdose can occur in one massive dose or gradually over a period of days or weeks if taken in high doses chronically. Older people are more likely to be sensitive to the potentially damaging effects of aspirin on the kidneys. This gentleman had developed acute kidney failure. He subsequently ended up on peritoneal dialysis as his kidneys were permanently damaged.

More from The Allied Times

An Unusual Cause of Dyspnea

An Unusual Cause of Dyspnea The reasons behind difficulty breathing can be surprising.By Marven Ewen, MDMedical DirectorA stoic 73-year-old man was brought to the ED with dyspnea. He had a history of COPD and was administered albuterol en route to the hospital with no change in dyspnea.    I noticed his shoes were not tied.…

Raynaud's Phenomenon

 Raynaud’s PhenomenonThe vascular condition where cold fingers and toes aren’t just from winter weather.By Jenny Ewen, BA, NREMTEditor-In-ChiefOverviewAs the winter season settles upon us, feeling cold is a pretty common occurrence. Blood vessels near the surface of the skin will constrict when exposed to cold in order to push blood deeper in the body and…

Stress Eating: An Emotional Blackhole

Stress Eating: An Emotional Blackhole Stress and overeating can go hand in hand, but prevention is possible.By Mariah Xzena Briones, RMTCertification SpecialistAre your cravings immensely increasing when you’re bombarded with never-ending tasks at work? Have you noticed your study table being more occupied with snacks than books especially during exam week? Food cravings and increased…

A Trip to Africa

A Trip to Africa The threat of malaria must be considered when traveling.By Marven Ewen, MDMedical DirectorOne evening an aspiring 40 year old nature photographer was brought to the ER. He was feeling ill with intermittent fever for several days. He had malaise, arthralgias, a headache, and episodes of delirium. No one else in the…

Carpal Tunnel Syndrome

Carpal Tunnel Syndrome Early diagnosis is key to stopping progression of this condition.By Mariah Xzena Briones, RMTCertification SpecialistEMTs must use their hands and wrist to carry patients or move heavy objects for rescue operations. When the patient is critical for both time and condition, EMTs prioritize their patients and sometimes overuse their hands and wrists…

The Hidden Stroke

The Hidden Stroke Atrial fibrillation can be the culprit behind embolic stroke.By Marven Ewen, MDMedical DirectorJohn is a busy 58-year-old accountant who, during the previous week, had been feeling more tired than usual but thought he might be coming down with some sort of virus; however, the usual symptoms of a cold such as nasal…

Are you ready to start saving lives?