This 24-year-old lady was admitted at 9pm with wheeze and shortness of breath. Can you make the correct diagnosis?
History of presenting complaint
She was at a restaurant having dinner with her partner. She had just finished her main meal of lobster when she felt generally unwell. Within 15 minutes she had become quite distressed with a wheeze and short of breath. She felt her lips tingling and become a little swollen.
This lady is terrified and distressed. She is very wheezy and has marked angio-oedema affecting her lips. Her skin is quite flushed.
Past medical history
Asthma as a child.
Appendicectomy 4 years ago.
Allergic to aspirin.
Table 1: Vital signs on admission
|Blood pressure||84/60 mmHg in both arms|
|Pulse||Rate 120 per minute and regular|
|Respiratory rate||45 per minute|
|Oxygen saturation||86% on high flow oxygen|
Her full blood count and U&E’s were all within normal limits.
- Arterial blood gas showed acute respiratory acidosis with hypoxia. PO2was 9.2 kPa on high flow oxygen.