“Coughing Up Blood” part 2

Patient is intubated for airway protection. She is also resuscitated with 2 liters of IV crystalloid fluids.

Initial workup elicits the following:

Lab

  • WBC 10.2 (normal differential), Hgb 11.4, Plt 190K
  • Na+ 136, K+ 4.0, Cl 110, HCO3 24, BUN 52, Cr 2.6, Glucose 112
  • AST: 27, ALT 25, Total Bilirubin 0.2, Albumin 3.2
  • ABG: pH 7.48, PaCO2 31 mmHg, PaO2 84 mmHg
  • ESR: 85, CRP: 22
  • Urinalysis: Positive for large blood (with 3+ RBCs) and 2+ protein. Microscopy shows red blood cell casts

Imaging

  • Chest X-Ray: Diffuse bilateral patchy infiltrates

What’s on your differential diagnosis?

What would you do next in the work-up for this patient?

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