A 4- yr old boy, presented with fever and cough since 2 days, and difficulty in breathing since 1 day. During infancy, he was diagnosed to have a small (5 mm) subaortic ventricular septal defect with a left to right shunt without pulmonary arterial hypertension. Examination On examination, he had tachycardia, tachypnea, decreased air entry, prolonged expiration, and wheeze on both sides of the chest. SpO2 was 92% on 40% FiO2. The liver was 2 cm. below right costal margin.
A harsh pan systolic murmur was present in left parasternal area. Laboratory investigations Hemoglobin 14 g/dL Leukocyte count- total 8260/μL Serum sodium 141 mEq/L Potassium-3.4 mEq/L Urea- 20 mg/dL Creatinine- 0.3 mg/dL. Arterial blood gas analysis showed pH- 7.22, PaO2-65.7 torr, PaCO2- 50 torr Bicarbonate- 20.1 mEq/L, SaO2- 86.9%. Blood culture was sterile. The child was managed initially with restricted fluids,…
