A 25 year old previously healthy G1P0 at 30 weeks gestational age presents with uterine contractions. She was admitted to the hospital and started on terbutaline, a beta-2 agonist, for premature labor. The contractions stopped for 12 hours, but resumed 12 hours later, and she had a normal spontaneous vaginal delivery. The following day, the patient develops cough, dyspnea, and pink frothy sputum. She is transfered to the intensive care unit for mechanical ventilation. Her exam showed tachypnea, sinus tachycardia, no JVD, no murmurs, rubs, or gallops, and diffuse crackles. ABG is 7.50/ 30/60 on 40% FiO2. CXR is shown below.
Challenge: What is the diagnosis and the cause?Image shown under Creative Commons Attribution-Share-Alike 3.0
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4 comments:
amniotic fluid embolism?
hmmm, ARDS from pulmonary fat emboli?
Amniotic Fluid Embolism...?
oooh, interesting. the case was supposed to be a drug reaction to the terbutaline, but reading about amniotic fluid embolism, I think that has to be high on the differential. Nicely done!
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Happy Labor Day
This is pulmonary edema due to tocolytic therapy. In pregnancy hemodynamics (increased blood volume, cardiac output, intracapillary pressure, and decreased oncotic pressure), IV beta-agonists are associated with acute pulmonary edema. Respiratory failure occurs 12 hours after delivery when tocolytics have failed to prevent labor. Chest x-ray shows bilateral alveolar infiltrates.
Sources: UpToDate; Wikipedia.
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