Preterm labor presenting as acute pulmonary edema following administration of magnesium sulfate

Background: The accumulation of fluid in the pulmonary interstitial spaces is the pathophysiology of pulmonary edema. Infusion of fluids in women who submitted to induce labor, Caesarean section or prophylaxis with magnesium sulfate are cause of pulmonary edema. Objective: To describe an unusual complication of tocolytic administration.Case Report: A nulliparous 23 year--old woman was referred to our tertiary medical center for preterm labor and dyspnea. She had no past medical history. The patient complained of suddenly developed respiratory distress and fall on O2 saturation following administration of magnesium sulfate. She transferred to our third level intensive care unit (ICU).On arrival to ICU her blood pressure was 120 /75 and respiratory rate of 50 breath per minute and Spo2=90%, So 20 mg of furosemide injected and patients intubated because of respiratory distress. All necessary evaluations were performed for patient including chest radiography (fig 1), CT angiography (fig 2), echocardiography, complete work up for autoimmune disease and sepsis. A chest radiograph taken at bedside showed widespread interstitial shadowing consistent with pulmonary edema (fig 1(. There was no evidence of thromboembolic event in CT angiography report. On echocardiography cardiac function was normal and there was no sign of valvular heart disease or wall motion abnormality. Laboratory findings was as follows:WBC= 14. 4 Neut=89.1%. Alp=217 IU/L Anti ds DNA=0.2 IU/MlHb=11.4 g/dl Lymph=6.4 Bil total=0.7 mg/dl FANA=negative HCT=34.7% ALT=20 U/L Bil direct=0.5 mg/dlPlt=167/microlier AST=22U/L Procalcitonin<0.2 ng/mlABG before intubation: showed moderate respiratory alkalosis (PH=7.48, Paco2=32, HCO3=22 o2 sat= 89%)Medical team concluded to perform Cesarean section to improve respiratory conditions. After 24 hours of admission Caesarean section was performed and after that, the mechanical ventilation of the patient continued. Airway resistance under mechanical ventilation was about 10 to 15 cm H2O and a static compliance was about 33 cm H2O. We performed an open lung maneuver with Airway pressure release ventilation mode (A.P.R.V) for 24 hours. Intravenous furosemide (bolus 40 mg over 2 min) was used and it was repeated 30 min after that and continued with infusion of it for 24 hours. Chest X-radiography the following day showed a normal lung and we successfully extubated patient after 48 hours of Cesarean section. The Patient got better and was discharged one week after ICU admission.Conclusions: Pharmacological agents are one of the defendants for lung edema during pregnancy. It is important to pay attention to lung edema due to tocolytic administration

کلیدواژه ها:

pulmonary edema ، magnesium sulfate ، tocolytic ، pregnancy