Pulmonary edema laboratory tests: Difference between revisions
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==Overview== | ==Overview== | ||
Laboratory findings consistent with the diagnosis of pulmonary edema include [[hypoxia]], [[hypercapnia]], [[acidosis]]. Elevated [[B-type natriuretic peptide]] (BNP) and [[Cardiac enzymes|cardiac enzyme]] is usually suggestive of cardiogenic pulmonary edema. | |||
==Laboratory Findings== | ==Laboratory Findings== | ||
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><ref name="pmid21219673">{{cite journal |vauthors=Murray JF |title=Pulmonary edema: pathophysiology and diagnosis |journal=Int. J. Tuberc. Lung Dis. |volume=15 |issue=2 |pages=155–60, i |date=February 2011 |pmid=21219673 |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><ref name="pmid21219673">{{cite journal |vauthors=Murray JF |title=Pulmonary edema: pathophysiology and diagnosis |journal=Int. J. Tuberc. Lung Dis. |volume=15 |issue=2 |pages=155–60, i |date=February 2011 |pmid=21219673 |doi= |url=}}</ref> | ||
==== Arterial blood gas test: ==== | ==== Arterial blood gas test: ==== | ||
* [[Hypoxia]] : | * [[Hypoxia]]: | ||
** [[Oxygen saturation]] < 90% | ** [[Oxygen saturation]] < 90% | ||
** [[PaO2]] < 60 mm Hg | ** [[PaO2]] < 60 mm Hg | ||
| Line 23: | Line 23: | ||
==== Serum albumin: ==== | ==== Serum albumin: ==== | ||
* | * [[Albumin]] may be low in pulmonary edema | ||
==== Liver function tests: ==== | ==== Liver function tests: ==== | ||
| Line 32: | Line 32: | ||
* A low BNP (<100 pg/ml) makes a cardiac cause very unlikely and is associated with non-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 [[Pulmonary capillary wedge pressure|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. | |||
==== Shunt fractions (Qs/Qt): ==== | |||
* Patients with non-cardiogenic pulmonary edema had greater shunt fractions(Qs/Qt) than patients with cardiogenic pulmonary edema.<ref name="pmid448782">{{cite journal |vauthors=Siegel JH, Giovannini I, Coleman B |title=Ventilation:perfusion maldistribution secondary to the hyperdynamic cardiovascular state as the major cause of increased pulmonary shunting in human sepsis |journal=J Trauma |volume=19 |issue=6 |pages=432–60 |date=June 1979 |pmid=448782 |doi= |url=}}</ref> | |||
<div class="center"> | |||
{| border="1" | {| border="1" | ||
|+ Differentiation of cardiogenic pulmonary edema and noncardiogenic pulmonary edema | |+ '''Differentiation of cardiogenic pulmonary edema and noncardiogenic pulmonary edema''' | ||
! Laboratory findings | ! Laboratory findings !! Cardiac enzymes !!BNP!! PCWP !! QS/QT !! | ||
|- | |- | ||
! Cardiogenic pulmonary edema | ! Cardiogenic pulmonary edema | ||
|| May be elevated ||High|| >18 mmHg || Small elevated || | |||
|- | |- | ||
! Noncardiogenic pulmonary edema | ! Noncardiogenic pulmonary edema | ||
| Usually normal || | || Usually normal || Low||<18 mmHg || Large elevated || | ||
|} | |} | ||
</div> | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Latest revision as of 14:42, 19 March 2018
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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 consistent with the diagnosis of pulmonary edema include hypoxia, hypercapnia, acidosis. Elevated B-type natriuretic peptide (BNP) and cardiac enzyme is usually suggestive of cardiogenic pulmonary edema.
Laboratory Findings
Laboratory findings consistent with the diagnosis of pulmonary edema include:[1][2][3]
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.
Shunt fractions (Qs/Qt):
- Patients with non-cardiogenic pulmonary edema had greater shunt fractions(Qs/Qt) than patients with cardiogenic pulmonary edema.[4]
| Laboratory findings | Cardiac enzymes | BNP | PCWP | QS/QT | |
|---|---|---|---|---|---|
| Cardiogenic pulmonary edema | May be elevated | High | >18 mmHg | Small elevated | |
| Noncardiogenic pulmonary edema | Usually normal | Low | <18 mmHg | Large elevated |
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.
- ↑ Murray JF (February 2011). "Pulmonary edema: pathophysiology and diagnosis". Int. J. Tuberc. Lung Dis. 15 (2): 155–60, i. PMID 21219673.
- ↑ Siegel JH, Giovannini I, Coleman B (June 1979). "Ventilation:perfusion maldistribution secondary to the hyperdynamic cardiovascular state as the major cause of increased pulmonary shunting in human sepsis". J Trauma. 19 (6): 432–60. PMID 448782.