Pulmonary Oedema Induced by a Piece of Chicken

Abstract

supraventricular tachycardia. There was no apparent cause such as intercurrent illness, drug therapy, vomiting or diarrhoea. Renal function, plasma sodium and plasma cortisol were all within normal limits, as was 24 h potassium excretion (64 mmol/L at a time when plasma sodium was 2.8 mmol/L). Aldosterone and renin studies were not performed. The patient died after three months and necropsy was not done. COMMENTThis patient had features compatible with sporadic CJD (Box 1). The progressive worsening of hypokalaemia that accompanied his neurological deterioration raised the question whether CJD can affect potassium metabolism. This hypothesis is somewhat weakened by the presence of mild hypokalaemia a year before onset of symptoms. Clinically, the hypokalaemia and its effects were very hard to manage. The possible association with CJD deserves further exploration. After acute airway obstruction by a foreign body, removal of the offending object generally leads to swift recovery. A rare complication is negative-pressure pulmonary oedema. CASE HISTORYA previously healthy man aged 47 choked while eating a piece of boneless chicken breast, and a Heimlich manoeuvre was immediately performed. The apparent airway obstruction was improved but he continued to cough vigorously, producing blood-stained frothy sputum. He also reported increasing dyspnoea and retrosternal pain. On admission to hospital three hours after the incident the patient was still coughing and pulse oximetry showed an oxygen saturation of 92% on room air. On examination the trachea was central; percussion of the chest was dull over the right base and midzone with poor air entry and coarse crackles. No radio-opaque foreign body was visible on chest radiography but there was haziness in all lung fields except for the right middle lobe.Acute airway obstruction by a foreign body was diagnosed and the patient underwent urgent bronchoscopy and rigid endoscopic assessment of the bronchial tree. No foreign body was found, but copious frothy bloody secretions were suctioned from both main bronchi. Despite the appearance of the chest X-ray, the area of the right middle lobe bronchus was endoscopically no different from the remainder of the tracheo-bronchial tree. A rigid oesophagoscopy was also performed, but again no foreign body was retrieved. Oxygen saturation remained around 90% throughout this procedure despite administration of 100% oxygen. When extubation was attempted the patient became restless and was unable to maintain oxygenation. He was reintubated and transferred to the intensive care unit for ventilation. Treatment with intravenous metronidazole and cefuroxime was started.A CT scan of the chest did not reveal any focal lesion but over the next few days oxygenation became increasingly difficult to maintain. The patient had to be ventilated withA u g u s t 2 0 0 2

Post-obstructive pulmonary edema from aspirated nuts

“…Whether the addition of diuretics plays a role in the resolution of POPE is not clear. 2,3 Mild pulmonary edema can be treated with supplemental oxygen alone. More severe pulmonary edema may require intubation and positive pressure ventilation.…”

“…Post-obstructive pulmonary edema (POPE) has most frequently been described after an upper airway obstruction. 1–3 We report the case of a 13-month-old boy who developed POPE following acute respiratory distress from an obstruction of the distal trachea following aspiration of a foreign body (FB). This case illustrates the importance of considering FB aspiration as a cause of POPE.…”