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Query: UMLS:C0034063 (pulmonary edema)
 10,665 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The absence of osmotic diuresis modifies the effects of hyperglycemia on body fluids in patients with advanced renal failure. To determine the relationship between clinical manifestations and abnormalities in tonicity and extracellular volume in such patients, we analyzed 43 episodes of severe dialysis-associated hyperglycemia (serum glucose exceeding 600 mg/dL) treated only with insulin. The main manifestations were dyspnea in 22 cases (pulmonary edema in 19), nausea and vomiting in 15, coma in 13 and seizures in 3, while 5 patients had no symptoms. Treatment with insulin resulted in a decrease in serum glucose value from 913 +/- 197 mg/dL to 170 +/- 78 mg/dL, an increase in serum sodium level from 125 +/- 5 to 136 +/- 5 mmol/L, and a fall in calculated serum tonicity value from 300 +/- 13 to 282 +/- 11 mmol/kg (all at p < 0.001). The ratio of the change in serum sodium level over change in serum glucose concentration was -1.50 +/- 0.22 mmol/L per 100 mg/dL. The percent increase in extracellular volume secondary to hyperglycemia developing from the prior euglycemic state and calculated from changes in serum sodium and chloride concentrations, was 10.9% +/- 4.6% (1.5% +/- 0.6% per 100 mg/dL increase in serum glucose level). All clinical manifestations dissipated after correction of hyperglycemia in 42 patients. One woman developed during treatment a fatal myocardial infarction. Dialysis patients with severe hyperglycemia may develop symptoms as a result of hypertonicity and extracellular expansion. Insulin alone may be sufficient treatment for these symptoms. The changes in serum tonicity and electrolytes during treatment are consistent with theoretical predictions.
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PMID:Serum tonicity, extracellular volume and clinical manifestations in symptomatic dialysis-associated hyperglycemia treated only with insulin. 1552 Dec 14

Dimethyl sulphate (DMS) is an innocuous appearing, widely used, and highly toxic chemical. It is used both as a methylating agent in industrial chemical synthesis and in medical laboratories for chemical cleavage of DNA. It is readily absorbed through the skin, mucous membranes, and gastrointestinal tract. Delayed toxicity allows potentially fatal exposures to occur prior to development of any warning symptoms. Toxicity is manifested initially by mucosal inflammation of eyes, nose, oropharynx, and airways. This can progress to severe airway oedema and necrosis, and non-cardiogenic pulmonary oedema. Other systemic effects include convulsions, delirium, coma, and renal, hepatic, and cardiac failure. All these features make DMS a potential chemical weapon. We report nine cases of varying degrees of inhalational exposure to DMS, occurring as a result of a single chemical spillage incident in the United Kingdom. Industrial poisoning is surprisingly rare and there are few previous reports in the literature outside China.
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PMID:Nine cases of accidental exposure to dimethyl sulphate--a potential chemical weapon. 1629 99

We herein describe the clinical course of a consecutive series of fulminant hepatic failure patients treated with a molecular adsorbent recirculating system (MARS), a cell-free albumin dialysis technique. From November 2000 to September 2002, seven adult patients ages 22-61 (median, 41), one male (14.2%) and six females (85.7%), affected by fulminant hepatic failure underwent seven courses (one to five sessions each, 6 hr in duration) of extracorporeal support using the MARS technique. Pre- and posttreatment blood glucose, liver function tests, ammonia, arterial lactate, electrolytes, hemodynamic parameters, arterial blood gases, liver histology, Glasgow Coma Scale, and coagulation studies were reviewed. No adverse side effects such as generalized bleeding on noncardiogenic pulmonary edema, often seen during MARS treatment, occurred in the patients included in this study. Six patients (85.7%) are currently alive and well, and one (14.2%) died. Four patients (57%) were successfully bridged (two patients in 1 day and two other patients in 4 days) to liver transplantation, while two (5%) recovered fully without transplantation. All the measured variables stabilized after commencement of the MARS. No differences were noted between the pre- and the post-MARS histology. We conclude that the MARS is a safe, temporary life support mechanism for patients awaiting liver transplantation or recovering from fulminant hepatic failure.
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PMID:Fulminant hepatic failure bridged to liver transplantation with a molecular adsorbent recirculating system: a single-center experience. 1641 11

A 34-year-old oligophrenic woman was admitted in comatose state with marked tachypnea. History revealed the oral ingestion of a large amount of acetylsalicylate to attenuate ear pain within the preceding 3 days. Laboratory investigations showed a toxic concentration of serum salicylate (668 mg/l, toxic range above 200 mg/l) and metabolic acidosis. Oxygenation, blood pressure, electrocardiography, echocardiography and CT of thorax and brain were normal. The patient was intubated, fluid and bicarbonate was given intravenously. Six hours after admission asystolia refractory to resuscitation led to death. Autopsy showed venous congestion of the brain, cardiac dilatation and pulmonary edema. Brain histopathology showed myelin disintegration and caspase-3 activation in glial cells, whereas, grey matter changes were sparse. Acute white matter damage is suggested to be the substrate of cerebral dysfunction in salicylate intoxication and possible mechanisms are discussed.
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PMID:Acute cerebral white matter damage in lethal salicylate intoxication. 1693 Jul 16

Lung involvement in malaria has been recognized for more than 200 hundred years, yet our knowledge of its pathogenesis and management is limited. Pulmonary edema is the most severe form of lung involvement. Increased alveolar capillary permeability leading to intravascular fluid loss into the lungs is the main pathophysiologic mechanism. This defines malaria as another cause of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS).Pulmonary edema has been described most often in non-immune individuals with Plasmodium falciparum infections as part of a severe systemic illness or as the main feature of acute malaria. P.vivax and P.ovale have also rarely caused pulmonary edema.Clinically, patients usually present with acute breathlessness that can rapidly progress to respiratory failure either at disease presentation or, interestingly, after treatment when clinical improvement is taking place and the parasitemia is falling. Pregnant women are particularly prone to developing pulmonary edema. Optimal management of malaria-induced ALI/ARDS includes early recognition and diagnosis. Malaria must always be suspected in a returning traveler or a visitor from a malaria-endemic country with an acute febrile illness. Slide microscopy and/or the use of rapid antigen tests are standard diagnostic tools. Malaria must be treated with effective drugs, but current choices are few: e.g. parenteral artemisinins, intravenous quinine or quinidine (in the US only). A recent trial in adults has shown that intravenous artesunate reduces severe malaria mortality by a third compared with adults treated with intravenous quinine. Respiratory compromise should be managed on its merits and may require mechanical ventilation.Patients should be managed in an intensive care unit and particular attention should be paid to the energetic management of other severe malaria complications, notably coma and acute renal failure. ALI/ARDS may also be related to a coincidental bacterial sepsis that may not be clinically obvious. Clinicians should employ a low threshold for starting broad spectrum antibacterials in such patients, after taking pertinent microbiologic specimens. Despite optimal management, the prognosis of severe malaria with ARDS is poor.ALI/ARDS in pediatric malaria appears to be rare. However, falciparum malaria with severe metabolic acidosis or acute pulmonary edema may present with a clinical picture of pneumonia, i.e. with tachypnea, intercostal recession, wheeze or inspiratory crepitations. This results in diagnostic confusion and suboptimal treatment. Whilst this is increasingly being recognized in malaria-endemic countries, clinicians in temperate zones should be aware that malaria may be a possible cause of 'pneumonia' in a visiting or returning child.
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PMID:Pulmonary manifestations of malaria : recognition and management. 1715 71

Bencyclane relaxes smooth muscles of vasculature and has been used in the treatment of peripheral and cerebral circulation disorders. Bencyclane penetrates the blood brain barrier and may evoke various adverse central effects, such as psychotic episodes, coma, and convulsions. It also decreases arterial pressure by vasodilatation and has negative inotropic action. The cardiodepressive action of bencyclane is caused probably by a direct calcium-channel antagonistic mechanism. The case of a 23-year old man, addict on amphetamine, who ingested 5 g of bencyclane (Halidor) is presented. The patient developed coma, convulsions, shock and cardiogenic pulmonary edema. He required mechanical ventilation, treatment with pressure amines (dopamine and dobutamine) and calcium. The circulatory and respiratory insufficiency persisted to the seventh day of hospitalization, then the patient was completely recovered and confirmed suicidal ingestion of 50 tablets a 100 mg of Halidor. In cases of severe bencyclane intoxications most important is an intensive symptomatic treatment. In these cases extracorporeal methods of toxin elimination from the blood are probably completely inutile, because of large bencyclane volume of distribution.
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PMID:[Severe bencyctane intoxication--a case report]. 1772 91

Cardiac complications often accompany poisoning with organophosphates. These may be serious and often fatal, being represented by cardiac arrhythmias, electrocardiographic abnormalities and conduction defects, as well as myocardial infarction, a rarely reported complication of acute pesticide poisoning. The extent and pathogenesis of cardiac toxicity from these compounds is not yet clearly defined. We report the case of a 57-year-old woman who presented to our emergency department with coma and acute non-cardiogenic pulmonary edema, as a result of organophosphates ingestion. She was resuscitated for asystole presented shortly after admission; prolonged QTc interval, ST-T changes, right bundle branch block, ventricular tachycardia were recorded. Finally she developed acute anteroseptal myocardial infarction and died despite serum cholinesterase normalization. We believe that admission in an intensive care unit, careful electrocardiographic and enzymatic monitoring of all patients is important for the diagnosis and treatment of cardiac complications of organophosphates poisoning.
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PMID:[Electrocardiographic changes in acute organophosphate poisoning]. 1838 78

Intoxications of carbon monoxide are frequent and may affect systems of lung, heart, and brain, leading to coma or death in severe cases. In this case report, we present two adults who were exposed to the same source of carbon monoxide for a nearly equal period of time. The first patient, a 28-yr-old female, developed massive symptoms including loss of consciousness, respiratory insufficiency, and lung complications resulting in severe lung edema. She was intubated and ventilated for 43 h before she recovered and could be extubated. The other patient, a 22-yr-old male, recovered immediately and was fully orientated after applying an oxygen mask at the scene of incident. After admission to the intensive care unit, both patients showed an equally high serum level of COHb and received hyperbaric oxygen therapy. The male patient was discharged from hospital the following day, whereas the female remained in intensive care for 4 days. A satisfactory explanation could not be found for the difference in the clinical progression in these two cases. However, this case report shows that, in spite of almost equal serum levels of carboxyhemoglobin (COHb), the individual symptoms can vary extremely. Therefore, a detailed medical history, physical examination, supporting diagnostic measures, and the continuous monitoring of vital parameters in a specialized clinic are essential.
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PMID:The diversity of carbon monoxide intoxication: medical courses can differ extremely-a case report. 1866 9

We present a rare case of noncardiogenic pulmonary edema (NCPE) associated with sudden coma due to severe hypoglycemia. We suggest that in every case of NCPE associated with coma, a rapid determination of glycemia should be provided because delays in diagnosis can lead to adverse outcome.
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PMID:Noncardiogenic acute pulmonary edema due to severe hypoglycemia--an old but ignored cause. 1877 61

The aim of this retrospective descriptive study was to describe both epidemiologically and clinically manifestations following severe scorpion envenomation and to define simple predictive factors which can be used in routine practice in general Intensive Care Units (ICU) as an indicator of poor prognosis. Cases were collected from hospital patients' files during 13-year (1990-2002) period in the medical Intensive Care Unit of a university hospital (Sfax - Tunisia). The diagnosis of scorpion envenomation was based on a history of scorpion sting. Nine hundred fifty-one patients, who were admitted for a scorpion sting, were analyzed. There were 769 patients (80.8%) in the grade III group (with cardiogenic shock and/or pulmonary edema or severe neurological manifestation (coma and/or convulsion)) and 182 patients (19.2%) in the grade II group (with systemic manifestations). Scorpion envenomation is more frequent in summer; indeed 82.3% of our patients were admitted between June and September. The mean age (+/-SD) was 14.7 +/- 17.4 years, ranging from 0.5 to 90 years. In this study 739 patients (77.8%) had neuromuscular signs, 700 patients (73.6%) had gastrointestinal signs and 585 patients (61.5%) had a pulmonary edema, while 195 patients (20.5%) had a cardiogenic shock. The mean blood sugar on admission was at 11.32 +/- 5.66 mmol/l, a high blood sugar level (>11 mmol/l) was observed in 39% of cases. The mean blood urea was at 7.1 +/- 3.2 mmol/l, it was above 10 mmol/l in 10.7% of cases. The mean of leucocytes was at 17 418 +/- 7833 cells/mm(3), it was above 11 000/mm(3) in 80% of cases. In the end of the stay in ICU, evolution was marked by the improvement of 879 patients (92.5%) while 72 patients (7.5%) died. A multivariate analysis found the following factors to be correlated with a poor outcome: age less than 5 years (OR = 2.27), fever >38.5 degrees C (OR = 2.79), coma with Glasgow coma score < or =8/15 (OR = 9.87), pulmonary edema (OR = 8.46), leucocytes >25 000 cells/mm3 (OR = 2.35) and blood urea >8 mmol/l (OR = 4.02). Moreover, in children group, a significant association was found between PRISM score and mortality rate, this model had a high discriminative power with an area under the ROC curve at 0.93. In the adult patients a significant association was found between SAPS II score and mortality rate, this model had a high discriminative power with an area under the ROC curve at 0.82. In summary, in severe scorpion envenomation, age less than 5 years, fever >38.5 degrees C, coma with Glasgow coma score < or =8/15, pulmonary edema, leucocytes >25 000 cells/mm3 and blood urea >8 mmol/l were associated with a poor outcome.
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PMID:Epidemiological, clinical characteristics and outcome of severe scorpion envenomation in South Tunisia: multivariate analysis of 951 cases. 1893 73


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