URGENT: LUNG WATER

Pulmonary edema or fluid in the lungs


Numerous disorders lead to the accumulation of fluid or edema in the lungs.
Lungs (there are two) are normally air-filled; their main function being to take oxygen from the atmosphere, exchange it with carbon dioxide, and transfer the fresh oxygen to the blood for transport to all the cells in the body.
The lungs are spongy (comprised of multiple small sacs known as alveoli) organs located in the chest behind the rib cage. When fluid builds up in the alveoli, it interferes with the normal oxygen intake -- causing severe disturbances in body function.


Shortness of breath
Gasping for air
Shortness of breath with activity
Inability to sleep lying flat (need more than 2 pillows)
Wheezing sound with breathing
Wet gurgling sounds in the chest
Coughing a pinkish or blood-tinged frothy sputum
Weakness
Fatigue
Anxiety and restlessness
Pounding or Racing Heart rate
Chest pain or sudden shortness of breath at night waking the patient up
Breathing may completely stop for a few seconds during sleep
Swelling (fluid build up) in the feet and ankles
Fever and other symptoms may occur according to the specific etiology.


Heart disorders can cause fluid to back up in the blood vessels (veins) that carry blood away from the lungs to the heart. As a result of pressure build-up in these veins, excess fluid leaks out into the alveoli.

Heart disorders:

Heart attack (death of heart muscle) or Myocardial Infarction
Left-sided Heart Failure
Valvular heart disease -- poorly-functioning doors between heart's 4 chambers
Arrhythmias -- irregularities in heart rhythm
Cardiomyopathy -- enlarged, balloon- like myocarditis (i.e., infection of heart muscle)
Congenital (present at birth) heart diseases -- such as holes in the walls between heart chambers (i.e., atrial and Ventricular Septal Defects).
Endocarditis -- infection of the valves
High Blood Pressure
Volume or fluid overload -- too much liquid intake by a person with diseased heart or kidneys.
Thyroid disease (hypothyroid or hyperthyroid)
Beriberi (Vitamin B1 Deficiency)
Others:
Kidney (renal) failure
Pneumonia -- infection of the lungs
Pulmonary Embolism -- blockage of lung blood vessels due to air bubbles, fat, amniotic fluid (in newborns), or clotted blood
Pancreatitis -- irritation, infection, or damage to the pancreas.
Drug overdose -- heroin and others
Shock
Drowning
High altitude sickness -- rapid climbing to heights (mountains) can cause Pulmonary Edema and other problems.


History:
Symptoms
Illnesses
Medications
Surgeries
Habits
Family history
Birth history
Allergies
Travel history
Medical exam:
Patient will appear breathless with nasal flaring (sides of nose moving outward with each breath)
The pulse rate (heart rate) may be faster than normal (60-100 beats per minute)
The doctor, using a stethoscope, will hear the Fluid in the Lungs (rales and crepitations) and abnormal or extra heart sounds.
Tests:
Arterial blood gas test -- blood oxygen levels are lower than normal (hypoxia).
Blood test may show that carbon dioxide levels are lower than normal (hypocarbia).
Other blood tests may be necessary in diagnosing the cause (e.g., high CPK levels in heart attack and Amylase in pancreatitis).
Chest X-Ray will show Fluid in the Lungs.
Electrocardiogram (measures electrical activity of the heart), Echocardiogram (uses sound waves to create a picture of the heart), and CAT scan can also be helpful in pinpointing the exact cause of the edema.
A cardiologist (heart doctor) may be called to perform a cardiac catheterization or Swan-Ganz catheterization, which are techniques that can provide valuable information about the heart and edema.


Aim is to treat symptoms and remove or reduce the fluid
In sudden, severe cases:

Oxygen as needed
Morphine, furosemide, nitroglycerin, and other medications are given in the hospital to reduce Anxiety, improve circulation, and promote fluid excretion (diuresis) or peeing excess fluid.
The patient, once admitted, receives drugs (diuretics) over the next several days to assist in gradually reducing excess fluid (urination removes excess body water).
The weight and amount of fluid taken in and urinated is carefully measured.
Low salt diet
Fluid restriction
Before discharge, the patient sees a cardiologist and is sent home with a treatment plan and medications.



See causes
Asthma
Pneumonia
Chronic Obstructive Lung Disease
Hyperventilation or Panic Attack