Shafiq Anwer, Liaqat Javed.
Role of sodium bicarbonate solution nebulization in the treatment of acute severe asthma.
Pak J Med Res Jan ;43(2):92-4.

This is a case of 25 years young asthmatic patient which is ill since early childhood and admitting to indoor since many times in desperate conditions, with severe bronchospasm and difficulty in expectoration of sticky sputum. Patient has been given extensive therapy as indoor and relieving the symptoms. This time, the X-ray chest showing hyper inflated lung fields, lung functions tests cannot be performed because of severe dyspnoea. At the time of admission (9:00 P.M.), the arterial blood gases were done, pH= 7.311, PO2 =110.2, PCO2 = 45.5 and HCO3 = 22.5. Oxygen 6L/min with mask started, Hydrocortisone 300 mg i/v, salbutamol nebulizer solution inhalation 5mg six hourly, Ipratopium nebulizer 250 mg 6- hourly, Aminophylline 480 mg i/v infusion in 24 hours and cefotaxime 1 g i/v eight hourly were given. Next Day: At 8.30 pm, Patient was intubated and mechanical ventilation started and the same medications continued. After 2 hours the Hydrocortisone dose was increased to 500 mg i/v 4 hourly. Next Day At 9. A.M., the patient was evaluated and we observe that the ACMV Fio2= 100%, RR = 16, TV= 400, AWP= 70, pH of arterial Blood gases was 7.39 PO2 =73 mmHg PCO2= 55.8 mmHg and HCO3= 33.4 mmol/L. Epinephrine 0.5 mg four hourly s/c, NaHCO3 solution 2.1%. 10 ml nebulisation 6 hourly and erythromycin 500 mg i/v infusion 6 hourly were added. At 6.30 am sodium bicarbonate solution nebulization reduced to 5 mg/ 6 hourly, epinephrine stopped and the dose of Hydrocortisone reduced to 300mg 6 hourly. Next Day at 10:00 A.M. pH= 7.51, PO2= 89.3, PCO2= 32.8, HCO3=26.2 , NAHCO3 nebulization stopped, prednisolone tablets 30mg daily started, Erythromycin infusion changed to Erythromycin tablets and Hydrocortisone stopped. Approximately 40 hours after the mechanical ventilation was started, copius mucoid secretion was seen coming out through the endotracheal tube. This was regularly sucked out. Thereafter the airway resistance steadily decreased. Approximately after 60 hours, he was taken off the ventilator and after another day he was extubated. He made a full recovery and was not breathless on usual ambulation. His chest was clear on auscultation. Arterial blood gases at room air returned to normal. He was discharged after on inhaler bronchodilators, reducing dose of prednisolone tablet and oral antibiotic.

PakMediNet -Pakistan's largest Database of Pakistani Medical Journals - http://www.pakmedinet.com