Pulmonary oedema is accumulation of fluid in the alveoli due to an increase in pulmonary capillary venous pressure resulting from acute left ventricular failure.

This is an acute emergency.

Clinical Features

  • Breathlessness
  • Sweating
  • Cyanosis
  • Frothy blood-tinged sputum
  • Respiratory distress
  • Rhonchi
  • Crepitations.


Chest x-ray: Loss of distinct vascular margins, Kerley B lines, diffuse haziness of lung fields.


  • Initiate treatment urgently and admit.
  • Prop up patient in bed.
  • Administer needed drugs:
    • IV morphine 0.1–0.2mg/kg STAT may be repeated (watch for respiratory depression).
    • IV frusemide 0.5–2mg/kg/dose, maximum 6mg/kg/dose. Infusion – 0.05mg/ kg/hour.
    • Digitalize if not already on digoxin.
    • IV aminophylline 6mg/kg over 15 min then 0.9mg/kg/hour.
  • Give oxygen by nasal prongs or catheter.
  • Start on oral medication as soon as possible.
  • When the patient has stabilized, investigate to identify the cause.
  • Manage the underlying cause.
  • Refer to specialist:
  • If patient fails to respond to above therapy.
  • For definitive treatment of underlying cause