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

Meet AMT: Nathaniel H.

Meet AMT: Nathaniel H. We interview our staff members for details on their EMS journey.When/why did you first become interested in becoming an EMT/working in EMS?  During the summer of 2014 between my junior and senior year of high school, I attended a national pre-medical camp at Johns Hopkins University for students interested in a…

The Best Napping Duration

The Best Napping Duration How long should your power naps be?By Mariah Xzena Briones, RMTCertification SpecialistGetting a quick nap offers several benefits and can serve as a reset button especially during mid-day. To fully enjoy the benefits of napping, there is actually a recommended nap length that can vary from person to person.   The…


 RosaceaWhen feeling flushed goes beyond a rise in body temperature.By Jenny Ewen, BA, NREMTEditor-In-ChiefOverviewEveryone experiences flushing of the cheeks – can be from exertion, from embarrassment, or even from some foods and drinks. A flush that is persistent and won’t go away can be a sign of rosacea. For middle-aged white women in particular, rosacea can…

Ectopic Pregnancy

Ectopic Pregnancy The facts behind this life-threatening condition.By Marven Ewen, MDMedical DirectorIt was another busy night in the ER. The patient was a 32-year-old woman who was brought to the emergency room complaining of severe abdominal pain and vaginal bleeding.    Her blood pressure was still normal but she was tachycardic and appeared pale. Her…

Early Indicators of Thyroid Problems

Early Indicators of Thyroid Problems Identifying early signs and symptoms of thyroid disorders.By Mariah Xzena Briones, RMTCertification SpecialistHormones control our bodily functions—body temperature, menstrual cycle, regulation of metabolism, muscle strength and more. A balance of hormones is necessary for regular function. Any variation from the optimal balance can result in health issues – the thyroid…

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.…

Are you ready to start saving lives?