Pulmonary edema laboratory tests: Difference between revisions
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Laboratory findings consistent with the diagnosis of pulmonary edema include:<ref name="pmid16382065">{{cite journal |vauthors=Ware LB, Matthay MA |title=Clinical practice. Acute pulmonary edema |journal=N. Engl. J. Med. |volume=353 |issue=26 |pages=2788–96 |date=December 2005 |pmid=16382065 |doi=10.1056/NEJMcp052699 |url=}}</ref><ref name="pmid6617283">{{cite journal |vauthors=Sibbald WJ, Cunningham DR, Chin DN |title=Non-cardiac or cardiac pulmonary edema? A practical approach to clinical differentiation in critically ill patients |journal=Chest |volume=84 |issue=4 |pages=452–61 |date=October 1983 |pmid=6617283 |doi= |url=}}</ref> | Laboratory findings consistent with the diagnosis of pulmonary edema include:<ref name="pmid16382065">{{cite journal |vauthors=Ware LB, Matthay MA |title=Clinical practice. Acute pulmonary edema |journal=N. Engl. J. Med. |volume=353 |issue=26 |pages=2788–96 |date=December 2005 |pmid=16382065 |doi=10.1056/NEJMcp052699 |url=}}</ref><ref name="pmid6617283">{{cite journal |vauthors=Sibbald WJ, Cunningham DR, Chin DN |title=Non-cardiac or cardiac pulmonary edema? A practical approach to clinical differentiation in critically ill patients |journal=Chest |volume=84 |issue=4 |pages=452–61 |date=October 1983 |pmid=6617283 |doi= |url=}}</ref> | ||
==== | ==== Arterial blood gas test: ==== | ||
* [[Hypoxia]] : | * [[Hypoxia]] : | ||
** [[Oxygen saturation]] < 90% | ** [[Oxygen saturation]] < 90% | ||
** [[PaO2]] < 60 mm Hg | ** [[PaO2]] < 60 mm Hg | ||
* [[Hypercapnia]]: | * [[Hypercapnia]]: | ||
| Line 23: | Line 23: | ||
==== Serum albumin: ==== | ==== Serum albumin: ==== | ||
* May be low | |||
==== Liver function tests: ==== | ==== Liver function tests: ==== | ||
* Elevation in [[alanine aminotransferase]], [[aspartate aminotransferase]] and [[bilirubin]] may be seen in [[right ventricular failure]] as underlying cause of cardiogenic pulmonary edema | |||
==== Plasma brain natriuretic peptide levels : ==== | ==== Plasma brain natriuretic peptide levels : ==== | ||
[[Brain natriuretic peptide|B-type natriuretic peptide]] (BNP) is elevated in the patient with | * [[Brain natriuretic peptide|B-type natriuretic peptide]] (BNP) is elevated in the patient with cardiogenic pulmonary edema. | ||
* A low BNP (<100 pg/ml) makes a cardiac cause very unlikely and is associated with non-cardiogenic pulmonary edema. | |||
{| border="1" | {| border="1" | ||
|+ Differentiation of cardiogenic pulmonary edema and noncardiogenic pulmonary edema | |+ Differentiation of cardiogenic pulmonary edema and noncardiogenic pulmonary edema | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Farnaz Khalighinejad, MD [2]
Overview
Laboratory Findings
Laboratory findings consistent with the diagnosis of pulmonary edema include:[1][2]
Arterial blood gas test:
- Hypoxia :
- Oxygen saturation < 90%
- PaO2 < 60 mm Hg
- Hypercapnia:
- CO2 > 45–55 mm Hg
- Acidosis:
- PH < 7.35 nEq/liter
- Early findings of pulmonary edema may be respiratory alkalosis because of hyperventilation
Serum albumin:
- May be low
Liver function tests:
- Elevation in alanine aminotransferase, aspartate aminotransferase and bilirubin may be seen in right ventricular failure as underlying cause of cardiogenic pulmonary edema
Plasma brain natriuretic peptide levels :
- B-type natriuretic peptide (BNP) is elevated in the patient with cardiogenic pulmonary edema.
- A low BNP (<100 pg/ml) makes a cardiac cause very unlikely and is associated with non-cardiogenic pulmonary edema.
| Laboratory findings | ECG | CXR | Cardiac enzymes | PCWP | QS/QT | Edema fluid/serum protein |
|---|---|---|---|---|---|---|
| Cardiogenic pulmonary edema | Ischemia/Infarct | Peri-hilar distribution | May be elevated | >18 mmHg | Small elevated | <.5 |
| Noncardiogenic pulmonary edema | Usually normal | Peripheral distributions | Usually normal | <18 mmHg | Large elevated | <.7 |
References
- ↑ Ware LB, Matthay MA (December 2005). "Clinical practice. Acute pulmonary edema". N. Engl. J. Med. 353 (26): 2788–96. doi:10.1056/NEJMcp052699. PMID 16382065.
- ↑ Sibbald WJ, Cunningham DR, Chin DN (October 1983). "Non-cardiac or cardiac pulmonary edema? A practical approach to clinical differentiation in critically ill patients". Chest. 84 (4): 452–61. PMID 6617283.