Uncommon Causes of Noncardiogenic Pulmonary Edema (NCPE) - Differential Diagnosis Framework High Altitude Pulmonary Edema: • Accumulation of plasma and some red blood cells in the lung due to an interruption in the pulmonary blood-gas barrier. • High-altitude pulmonary edema (HAPE) generally occurs above 2,500 m (8,000 ft) and is uncommon below 3,000 m (10,000 ft) • Symptoms: - Nonproductive cough, shortness of breath with exertion, difficulty walking uphill - Dyspnea at rest will become severe with any type of exertion - Cough may be productive for pink, frothy sputum, as well as frank blood. - Lethargic and severely hypoxemic. • Other common assessment findings associated with HAPE are: - Tachypnea, - Low-grade fever (up to 100.4°F [38°C]), - Tachycardia, - Inspiratory crackles in the right middle lobe that become bilateral and diffuse Neurogenic Pulmonary Edema: • Traumatic brain injury, cerebral hemorrhage, and seizure activity, especially status epilepticus • Pathophysiology: The shift of fluid from the capillaries to the pulmonary interstitium and alveoli thus increases the permeability of the pulmonary capillaries • Criteria: - Bilateral pulmonary opacities, - Amount of oxygen dissolved in the PaO2/FiO2 ratio < 200 mm Hg, - Presence of central nervous system injury (with associated increased intracranial pressure), - Absence of other common causes of acute respiratory failure or ARDS (aspiration, massive blood transfusion, sepsis), - No evidence of left atrial hypertension TRALI: • Sudden onset of hypoxemic respiratory insufficiency shortly after or during the administration of a blood product. • Symptoms: Hypoxemic respiratory insufficiency, fever, chills, pruritus, urticaria, pulmonary infiltrates on chest radiography, pink frothy airway secretions, hypotension, hypovolemia, cyanosis, tachycardia, and tachypnea Preeclampsia/Eclampsia Pulmonary Edema: • Pathophysiology: - Poor uteroplacental circulation caused by inadequate remodeling of the spiral arteries that happens between weeks 8 and 18 of pregnancy. - The predominant pathophysiologic finding: maternal vasospasm. • Signs/Symptoms: Tachycardia, hypertension, dyspnea, tachypnea, hypoxemia, scattered crackles, chest pain, cough Opioid Overdose: • Any opioid can cause noncardiogenic pulmonary edema, especially fentanyl mixed with heroin, and methadone overdose. • Signs/Symptoms: - Respiratory depression and/or agonal respirations. - The classic signs of opioid intoxication include depressed mental status, decreased respiratory rate, decreased tidal volume, decreased bowel sounds, and miotic pupils Pulmonary Embolism: • Acute pulmonary edema can be caused by a massive PE, as well as multiple smaller emboli. • Pathophysiology: - PE can cause noncardiogenic pulmonary edema by decreasing the pulmonary and adjacent pleural systemic circulations, raising hydrostatic pressures in pulmonary and systemic veins, and also decreasing pleural pressure due to airway collapse. - PE also reduces the exit rates of pleural fluid by rising the systemic venous pressure thus limiting lymphatic drainage. Increasing lymphatic filling can also occur with a PE by diminishing pleural pressure. #Noncardiogenic #pulmonary #edema #causes #differential #diagnosis #NCPE
