Changes in pulmonary venous pressure and albumin concentration during treatment of severe diabetic decompensation

Pulmonary capillary wedge pressure (PCWP), serum albumin concentrations, and arterial oxygenation (PaO2) were monitored during crystalloid loading in 10 patients with severe decompensated diabetic states (SDDS). Rapid infusion of crystalloid induced marked rises in PCWP (median 6 mmHg, range 1-21 mmHg) and falls in albumin concentrations (median 5 g/l, range 0.8-15 g/l) over the first few hours of treatment. PaO2 was significantly related (r(s) = -0.25, p less than 0.05) to the calculated hydrostatic forces across the pulmonary capillary bed. However, hypoxaemia was found at initiation of therapy in 2 patients where calculated COP greatly exceeded PCWP. Hypoxaemia developing during crystalloid loading for SDDS may imply the formation of sub-clinical pulmonary oedema and the subsequent fluid replacement regimen should then be appropriately reviewed.