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Non Cardiogenic Pulmonary Edema Due to Chronic BC Powder Use
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A6910 - Non Cardiogenic Pulmonary Edema Due to Chronic BC Powder Use
Author Block: T. Warmoth1, H. Edriss2; 1Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, United States, 2Pulmonary and critical care, Texas Tech University Health Science Center, Lubbock, TX, United States.
Taylor Warmoth, Hawa Edriss
Introduction: The diagnosis of salicylate toxicity during chronic use can be challenging due to the lack of acute insult and the lack of clinicians’ awareness that regular administration of a relatively safe medication can cause acute pulmonary edema. In addition, its presentation can mimic other conditions especially volume overload. This case demonstrates that it is imperative to recognize this clinical presentation and to order appropriate laboratory tests to initiate critical treatment.
Case summary: A 51-year-old woman with a medical history of multiple sclerosis presented with generalized weakness, dyspnea, and cough for several days. Vital signs: temperature 97°F, blood pressure 97/57 mmHg, heart rate 89 beats/min, respiratory rate 18 breaths/min, SpO2 85% on nonrebreather. Physical exam: oriented but lethargic and bilateral diffuse crackles on chest examination. Patient was intubated for acute hypoxemic respiratory failure. Lab: white blood count 18 k/μL, sodium 144mmol/L, potassium 5.1mmol/L, chloride 108mmol/L, CO2 14mmol/L, AG 22, creatinine 1.5mg/dl, salicylate 29.6mg/dl (3-20), lactic acid 1.2 mmol/L. Arterial blood gases: pH 7.29, PCO2-34, PaO2 110 on FiO2 50%. Patient was presumptively treated for community-acquired pneumonia. However, she continued to be hypoxemic and her chest X-ray revealed diffuse interstitial infiltrates. Echocardiography demonstrates normal heart function with an EF of 60-64%. Acute drug toxicity was suspected, and further questioning revealed that she had been taking a large amount of BC powder over several months for migraines. The patient was treated with bicarbonate infusion and diuresis. She was able to be extubated after a few days. Discussion: Non-cardiogenic pulmonary edema is more common in patients with long-term ingestion of salicylates and tends to occurs in older patients. When no clear cause of pulmonary edema can be identified, salicylate toxicity should be investigated, especially in presence of an acid-base disorder. Salicylate concentrations should not be the primary method to determine treatment, as concentrations in chronic users may not be considered as toxic, and changes in concentration may cause misinterpretation of the patient’s clinical status. Early systemic alkalinization and hemodialysis are essential for treatment.
Author Block: T. Warmoth1, H. Edriss2; 1Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, United States, 2Pulmonary and critical care, Texas Tech University Health Science Center, Lubbock, TX, United States.
Taylor Warmoth, Hawa Edriss
Introduction: The diagnosis of salicylate toxicity during chronic use can be challenging due to the lack of acute insult and the lack of clinicians’ awareness that regular administration of a relatively safe medication can cause acute pulmonary edema. In addition, its presentation can mimic other conditions especially volume overload. This case demonstrates that it is imperative to recognize this clinical presentation and to order appropriate laboratory tests to initiate critical treatment.
Case summary: A 51-year-old woman with a medical history of multiple sclerosis presented with generalized weakness, dyspnea, and cough for several days. Vital signs: temperature 97°F, blood pressure 97/57 mmHg, heart rate 89 beats/min, respiratory rate 18 breaths/min, SpO2 85% on nonrebreather. Physical exam: oriented but lethargic and bilateral diffuse crackles on chest examination. Patient was intubated for acute hypoxemic respiratory failure. Lab: white blood count 18 k/μL, sodium 144mmol/L, potassium 5.1mmol/L, chloride 108mmol/L, CO2 14mmol/L, AG 22, creatinine 1.5mg/dl, salicylate 29.6mg/dl (3-20), lactic acid 1.2 mmol/L. Arterial blood gases: pH 7.29, PCO2-34, PaO2 110 on FiO2 50%. Patient was presumptively treated for community-acquired pneumonia. However, she continued to be hypoxemic and her chest X-ray revealed diffuse interstitial infiltrates. Echocardiography demonstrates normal heart function with an EF of 60-64%. Acute drug toxicity was suspected, and further questioning revealed that she had been taking a large amount of BC powder over several months for migraines. The patient was treated with bicarbonate infusion and diuresis. She was able to be extubated after a few days. Discussion: Non-cardiogenic pulmonary edema is more common in patients with long-term ingestion of salicylates and tends to occurs in older patients. When no clear cause of pulmonary edema can be identified, salicylate toxicity should be investigated, especially in presence of an acid-base disorder. Salicylate concentrations should not be the primary method to determine treatment, as concentrations in chronic users may not be considered as toxic, and changes in concentration may cause misinterpretation of the patient’s clinical status. Early systemic alkalinization and hemodialysis are essential for treatment.
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