MRCP2-4301
A 20-year-old Caucasian male presents with a two-day history of epigastric pain accompanied by nausea and vomiting. He was admitted under the surgical team for management of acute pancreatitis due to an elevated serum amylase level. The surgical team has requested a medical consult as the patient reports a worsening productive cough.
During your assessment, the patient reports that this is his third presentation with acute pancreatitis. He does not consume alcohol, and an ultrasound of the abdomen did not reveal any gallstones. The cough has been present for several months, initially dry but now productive of green sputum with no haemoptysis. He denies fever, chills, chest pain, and dyspnoea. Three weeks ago, he received a course of oral antibiotics from his General Practitioner after presenting with nasal congestion and mild facial pain. He states having had multiple courses of antibiotics in the past for similar presentations.
There is no significant past medical history or family history.
The patient takes no regular medications and has been receiving simple analgesia and intravenous crystalloid fluids under the surgical team’s care. He is a lifelong non-smoker and works full time in administration.
On examination, the patient’s height was 178cm with a weight of 58kg, heart rate 90/minute, blood pressure 100/60 mmHg, temperature 37.2ºC, respiratory rate 16/min, and oxygen saturation 94% on room air. Respiratory examination revealed early clubbing, no cervical lymphadenopathy, a central trachea, normal chest expansion, mild coarse inspiratory crepitations that improved somewhat after coughing at both posterior bases. Abdominal examination revealed mild epigastric tenderness but no signs of peritonism. Remaining clinical examination was unremarkable.
Lab results showed Hb 130 g/l, Na+ 136 mmol/l, Platelets 400 * 109/l, K+ 4 mmol/l, WBC 12 * 109/l, Urea 6 mmol/l, Neuts 10 * 109/l, Creatinine 65 µmol/l, Lymphs 1 * 109/l, and CRP 30 mg/l. Chest x-ray was normal.
Sputum microscopy and culture results revealed Pseudomonas aeruginosa.
What is the most appropriate management for this patient?