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