PULMONARY OEDEMA

Congestion of the lung tissue with fluid, usually due to heart
failure.

Cause

  • Cardiogenic
  • Severe fluid overload e.g. in renal failure or iatrogenic
  • Non-cardiogenic pulmonary oedema: severe pneumonia, altitude sickness, inhalation of toxic gases, acute respiratory distress syndrome

Clinical features

  • Severe dyspnoea, rapid breathing, breathlessness
  • Tachycardia, wheezing
  • Cough with frothy blood stained sputum

Differential diagnosis

  • Pneumonia, pleural effusion
  • Foreign body
  • Trauma (pneumothorax, pulmonary contusion)

Investigations

  • Chest X-ray
  • ECG
  • Renal function, electrolytes
  • Echocardiography

Management

Acute

  • Prop up patient in sitting position
  • High concentration oxygen : start with 5 L/min, aim at SpO2 >95%
  • Furosemide 40-80 mg IM or slow IV – Repeat prn up to 2 hourly according to responseChild: 0.5-1.5 mg/kg every 8-12 hours (max: 6 mg/
    kg) daily)
  • Glyceryl trinitrate 500 microgram sublingually every 4-6 hours
  • Give morphine 5-15 mg IM or 2-4 mg slow IVChild: 0.1 mg/kg slow IV single dose
  • Repeat these every 4-6 hours till there is improvement

Consider also

  • Digoxin loading dose IV 250 micrograms 3-4 times in the first 24 hours then maintenance dose of 125-250 micrograms dailyChild: 10 mg/Kg per dose as above then maintenance dose of 15 microgram/kg/day

Caution

  • Do not give loading dose if patient has had digoxin within the past 14 days but give maintenance dose

Prevention

  • Early diagnosis and treatment of cardiac conditions
  • Compliance with treatment for chronic cardiac conditions
  • Avoid fluid overload