Pulmonary edema laboratory tests

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Farnaz Khalighinejad, MD [2]

Laboratory Findings

Laboratory findings consistent with the diagnosis of pulmonary edema include:

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:

• Albumin may be low in pulmonary edema

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.

Pulmonary capillary wedge pressure(PCWP):

• A wedge pressure of 18 mmHg or higher is usually suggestive of cardiogenic pulmonary edema.
• A wedge pressure of less than 18 mmHg is usually suggestive of non-cardiogenic pulmonary edema.

Cardiac enzymes:

• Elevated concentration of troponin, may suggestive of damage to myocytes, as underlying cause of cardiogenic pulmonary edema.

Differentiation of cardiogenic pulmonary edema and noncardiogenic pulmonary edema

Laboratory findings	Cardiac enzymes	BNP	PCWP	QS/QT	Edema fluid/serum protein
Cardiogenic pulmonary edema	May be elevated	High	>18 mmHg	Small elevated	<.5
Noncardiogenic pulmonary edema	Usually normal	Low	<18 mmHg	Large elevated	<.7