BAL fluid LDH activity and LDH isoenzyme pattern in lipoid pneumonia caused by an intravenous injection of lamp oil

Abstract

B BA AL L f fl lu ui id d L LD DH H a ac ct ti iv vi it ty y a an nd d L LD DH H i is so oe en nz zy ym me e p pa at tt te er rn n i in n l li ip po oi idIn addition to " "foamy" " alveolar macrophages, bronchoalveolar lavage (BAL) fluid analysis showed an increased number of neutrophils. Moreover, lactate dehydrogenase (LDH) and alkaline phosphatase activities were elevated. The increase seen in LDH activity both in serum and BAL fluid was accompanied by shifts in the isoenzyme pattern in similar directions for both fluids. These findings suggest a pulmonary source for the temporary serum as well as BAL fluid LDH increase.This case indicates the usefulness of bronchoalveolar lavage fluid analysis as a probe to detect pulmonary injury caused by a pneumotoxicant and, probably, to monitor recovery or deterioration. Eur Respir J., 1996Respir J., , 9, 2416 Case report A 30 year old man was transferred to our hospital from a local hospital. Eight hours before admission he had attempted suicide by injecting 10 mL of lamp oil (liquid paraffin) into a vein in his left elbow. On admission, no abnormalities were found. Over the following hours, the patient's respiratory condition deteriorated requiring mechanical ventilation.Chest radiography revealed a diffuse reticulonodular infiltrative process. A bronchoalveolar lavage (BAL) was performed 2 days after admission. Simultaneously, blood samples were taken. No bacteria were seen on Gramstained preparations and culture of BAL fluid remained sterile. Further analysis of the BAL fluid revealed an increased number of cells (32×10 4 cells·L -1 ; reference value for nonsmokers 10.3±1.5×10 4 cells·L -1 ), predominantly polymorphonuclear neutrophils (52%; reference value for nonsmokers 1.3±0.2%) [1].Cell-free supernatant from BAL fluid as well as serum were assayed for lactate dehydrogenase (LDH) and alkaline phosphatase activities. Additionally, protein and albumin contents were determined in cell-free BAL fluid and serum. In serum, the total protein and albumin levels were decreased (table 1). LDH activity was increased in serum to 795 U·L -1 (reference range 200-450 U·L -1 ) [2,3], as well as in BAL fluid (115 U·L -1 ; reference range 20-59 U·L -1 ) (table 1). Alkaline phosphatase activity in BAL fluid was high (145 U·L -1 ; reference range 0-25 U·L -1 ), whereas in serum it was within normal limits (table 1). At this moment, all other laboratory tests including liver function tests were normal. Moreover, on cytocentrifuged preparations of the BAL fluid stained with May-Grünwald-Giemsa (MGG; Merck, Darmstadt, Germany) numerous lipid-laden, "foamy" alveolar macrophages were seen.The diagnosis lipoid pneumonia was based on the clinical picture and the cytological analysis of BAL fluid.

Modulation of lung inflammation by the Epstein-Barr virus protein Zta

“…BAL fluid was collected from mice in the three exposure groups on day 7 postexposure. Measurements of total protein and of the intracellular enzyme lactate dehydrogenase (LDH), indicators of mucosal permeability and cell lysis, respectively (18), were performed on the BAL fluid. Administration of the Adv-GFP control vector increased the protein concentration in the BAL fluid approximately twofold relative to the protein concentration in BAL fluid from mice exposed to PBS, whereas the mice treated with Adv-Zta displayed a greater than 10-fold increase in protein concentration relative to the PBS-exposed control mice ( Fig.…”

A 26-year-old transsexual male with acute respiratory distress and haemoptysis

“…Acute pneumonitis from mineral oil embolism has been sporadically reported after the intentional or accidental injection of mineral oil or as a complication of lymphangiography [6]. Pneumonitis and embolism from intravenous injection of mineral oil has been described in suicide attempts [7,8] and in an intravenous drug abuser who injected a mineral oil-containing solution in the mistaken belief it contained cocaine [9]. The best clinical descriptions of inadvertent pulmonary embolism of inert oils come from case reports or case series of subcutaneous silicone injection, describing patients attempting feminisation of the breasts, buttocks, hips or face [10][11][12].…”

Recurrent respiratory distress associated with carbamazepine overdose

“…3). Elevations of the LDH activity in lung tissue and serum, respectively, have been noted in many cases with a history of exposure to pneumotoxicants [17]. Lung parenchyma cells or local inflammatory cells including alveolar macrophages and polymorphonuclear neutrophils may be a potential source of LDH release [18].…”