Her initial chest roentgenogram demonstrated unchanged diffuse reticular nodular infiltrates consistent with her known diagnosis of sarcoidosis, but with superimposed bilateral air space disease also present. Findings from routine laboratory assessment were otherwise within normal limits. Over the first 24 hours of hospitalization, the patients arterial blood gas values deteriorated, revealing a room air Po, of 25 mm Hg, PcOj of 32 mm Hg, and a pH of 7.43. She was endotracheally intubated and supported with mechanical ventilation and transferred at that time. Buy Advair Diskus Online
At transfer, results of her physical examination were unrevealing, her chest roentgenogram was unchanged, and arterial blood gases while receiving an oxygen concentration of 50 percent revealed a Po2 of 76 mm Hg, Pco, of 35 mm Hg, and a pH of 7.43. When the history of mercury vapor exposure became apparent, dimercaprol (BAL) therapy at 5 mg/kg intramuscularly every 4 h was instituted along with intravenous corticosteroids. Serum and urine mercury levels obtained prior to chelation therapy were 12.7 (Lg/dl and 138 (ig/L, respectively. Despite increase in urinary excretion with therapy, serum mercury levels remained elevated throughout her hospitalization.