The pulmonary edema or pulmonary edema is a condition caused by the accumulation of fluid in the alveolar space in the lungs.
The accumulation of water in the lungs is due to a disease that alters the pressures within the lung and generates the presence of fluid where it was not previously, producing severe respiratory symptoms such as respiratory distress and a feeling of suffocation.
When water builds up quickly it is called acute lung edema and is a medical emergency as it must be treated as soon as possible.
Symptoms of pulmonary edema
In general, most patients with pulmonary edema present symptoms that can arise abruptly (acute lung edema) or progressively (chronic pulmonary edema), these are:
· Chest pain
· Cough with foamy and sometimes bloody expectoration.
· Feeling of suffocation
· Palpitation sensation.
· Gurgling or whistling sounds when breathing.
· Violet coloration of the mouth and fingers of the hands.
Causes of pulmonary edema
Whenever there is an accumulation of water in the lungs, an underlying disease must be ruled out that must be diagnosed promptly, since its development can be fatal. The causes of pulmonary edema are varied, from trauma to pneumonia, heart disease, tumors and altitude sickness, among others.
1. Pulmonary edema of cardiac origin
It occurs due to the inability of the left ventricle of the heart to pump enough blood throughout the body, generating congestion within the heart and increasing the pressure in the blood vessels that normally collect blood from the lungs, thus generating congestion at the level lung water accumulating in the lungs.
When this happens, it is said that there is congestive heart failure. Some diseases that cause heart failure are: myocardial infarction, endocarditis, diseases of the heart valves, chronic arterial hypertension associated with dilatation of the heart, among others.
2. Non-cardiogenic pulmonary edema
It is so important in the context of pulmonary edema to rule out cardiac pathologies that the rest of the causes are considered non-cardiogenic. Among these causes are:
1. Adult respiratory distress syndrome (ARDS)
It is due to the accumulation of fluid in one or both lungs, abruptly associated with a severe inflammatory reaction secondary to serious infectious processes (such as pneumonia and states of sepsis), trauma and acute bleeding.
2. Lung edema of the heights
It generally occurs in individuals who ascend rapidly to heights of 12,000 to 13,000 feet in elevation (3600 to 3900m), due to the sudden increase in pressure in the pulmonary capillaries. They represent a major cause of death in skiers and mountaineers.
3. Neurogenic edema
It occurs immediately after the release of neurotransmitters that increase blood flow to the lungs. This occurs due to the release of vasodilator substances, after head injuries, neurosurgery, seizures and brain hemorrhages.
4. Pulmonary edema due to re-expansion
It is generally unilateral, occurs after the rapid re-expansion of a previously collapsed lung (due to other causes such as the presence of fluid or air).
5. Overdose of opiates and salicylates
Some opiates such as heroin and methadone produce direct toxicity to the lung, generating fluid accumulation. The same can happen with the use of salicylates.
6. Secondary to pulmonary thromboembolism
The presence of an embolus in the lung circulation increases pressures and can increase the presence of water in the lungs.
7. Secondary to viral infections
Severe pulmonary edema has been described in cases of Hantavirus and Dengue Virus.
8. Hypoalbuminemia (low levels of albumin in the blood)
Because albumin is the protein that attracts water and keeps it inside the vessels, a decrease in its levels generates fluid leakage that accumulates in the lungs. Hypoalbuminemia occurs in cancer, severe malnutrition, liver disease, kidney disease, and in elderly patients.
It depends on the cause of the pulmonary edema. However, in all cases, the main treatment used is diuretics such as furosemide, combined with restriction of fluid intake.
In the case of edema of cardiac origin, heart failure must be compensated with drugs that improve the ejection fraction with which the left ventricle pumps blood towards the body (digitalis, angiotensin-converting enzyme inhibitors, and beta-blockers).
In the case of non-cardiogenic pulmonary edema, the etiology must be established. In the case of ARDS, the cause that originated it should be treated: in pneumonia antibiotics are indicated, in edema of the heights the descent begins, in hypoalbuminemia the protein intake in the diet is improved and albumin is replaced intravenously. Finally, in some cases where edema persists despite treatment, hemodialysis is required.
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