Reactions 1664, p16 - 12 Aug 2017
Non-cardiogenic pulmonary oedema: case report
A 61-year-old man developed non-cardiogenic pulmonary
oedema during treatment with acetazolamide.
The man was admitted to the ICU because of severe blunt
chest wall trauma due to a motor vehicle accident. He was on
prolonged ventilator support due to his chest wall instability
and cardiomyopathy. On day 17 of hospitalisation, to correct
metabolic alkalosis and increase urine output, he was
administered IV acetazolamide 500mg. He developed
tachycardia, hypertension and hypoxaemia one hour following
the injection of acetazolamide. Chest auscultation revealed
wheezing sounds, and a pinkish foamy secretion was removed
through his tracheal tube. He exhibited choking-like signs, and
his ventilator monitor revealed a very high airway pressure and
significantly decreased tidal volume, following which his
ventilation was changed to manual. A bilateral butterfly
shadow was revealed by chest radiography. An acute
pulmonary oedema due to acute exacerbation of congestive
heart failure was suspected.
The man received treatment for respiratory failure with
diuretics, nitric acid and a β
stimulant to reduce the airway
pressure. After approximately eight hours, the event resolved.
The man was administered the same dose of acetazolamide
five days after the previous episode for the same reason. He
had an abrupt incident of respiratory failure, which was the
same as the first episode. A very poor lung compliance and
slight increase in airway resistance was recorded on the
ventilator, which indicated that the high airway pressure was
due to pulmonary parenchymal oedema. An ECG showed a
hypercontractile left ventricle without signs of fluid overload.
He was administered β
blocker to suppress symptoms of
hypertension and tachycardia, following which the second
episode resolved spontaneously. The cardiac indexes
measured via radial arterial catheter indicated that his cardiac
output had increased during the episodes. Hence, a diagnosis
of pulmonary oedema caused by acetazolamide was made.
Author comment: "[We] encountered rare and potentially
fatal episodes of pulmonary [oedema] that was provoked by
treatment with acetazolamide."
Ono Y, et al. A case of non-cardiogenic pulmonary edema provoked by
intravenous acetazolamide. Acute Medicine and Surgery 4: 349-352, No. 3, Jul
2017. Available from: URL: http://doi.org/10.1002/ams2.279 - Japan
Reactions 12 Aug 2017 No. 16640114-9954/17/1664-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved