Pulmonary edema following diuretic therapy: A case report

Area of Science:

• Cardiology
• Pulmonology
• Critical Care Medicine

Background:

• Diuretics are standard treatment for acute pulmonary edema.
• Inappropriate diuretic use can precipitate acute pulmonary edema due to rapid intravascular volume depletion.
• This adverse effect of diuretic therapy remains underrecognized.

Observation:

• A patient with respiratory failure initially diagnosed with pneumonia and acute respiratory distress syndrome (ARDS) experienced worsening dyspnea after diuretic treatment.
• Point-of-care ultrasound (POCUS) revealed increased extravascular lung water during a hypovolemic state.
• The patient was diagnosed with acute pulmonary edema.

Findings:

• Excessive diuretic therapy led to hypovolemia, causing a left ventricular hyperdynamic state.
• This condition was identified as the cause of acute pulmonary edema.
• Treatment with intravenous fluids and a beta-receptor blocker resulted in significant improvement of respiratory distress.

Implications:

• This case highlights the importance of adhering to clinical practice guidelines for diuretic use.
• Maintaining appropriate volume status and utilizing beta-blockers are key to managing diuretic-induced pulmonary edema.
• POCUS is a valuable tool for rapid and accurate diagnosis of acute pulmonary edema etiology, guiding appropriate therapy.