Alveolar hemorrhage

Rats exposed to 42,000 ppm became hyperactive within the first 7 minutes, and at the end of 7 minutes they appeared lethargic and ataxic. After 95 minutes, the animals were completely anesthetized. There was no mortality when the exposure was terminated at the end of 5 hours, and most of the animals recovered completely within 40 minutes. Edema and alveolar hemorrhage were present in animals killed at termination of the single exposure, whereas bronchiolitis and pneumonitis were observed in rats killed 9 days after exposure. 

The irritant effects of sulfur dioxide are due to the rapidity with which it forms sulfurous acid on contact with moist membranes. Approximately 90% of all sulfur dioxide inhaled is absorbed in the upper respiratory passages, where most effects occur however, it may produce respiratory paralysis and may also cause pulmonary edema. In fatal cases, histopathologic examination of the lungs has revealed pulmonary edema and alveolar hemorrhage. ... 

Anticoagulants and continuous intravenous infusion of epoprostenol are the standard treatments for primary pulmonary hypertension. However, their combined use increases the likelihood of hemorrhagic complications, as demonstrated in a retrospective study of 31 consecutive patients with primary pulmonary hypertension (mean age, 29 years, 10 men, 21 women), nine of whom had 11 bleeding episodes nine episodes were cases of alveolar hemorrhage and two patients had severe respiratory distress (9). The mean dose of epoprostenol at the time of the first bleeding episode was 89 ng/kg/minute. More of the patients who had a bleeding episode died (67% versus 41%). 

Ogawa A, Matsubara H, Fujio H, Miyaji K, Nakamura K, Morita H, Saito H, Kusano KF, Emori T, Date H, Ohe T. Risk of alveolar hemorrhage in patients with primary pulmonary hypertension—anticoagulation and epoprostenol therapy. Circ J 2005 69(2) 216-20. 

Katayama K, Hata C, Kagawa K, Noda M, Nakamura K, Shimizu H, Fujimoto M. Diffuse alveolar hemorrhage associated with myeloperoxidase-antineutrophil cytoplasmic antibody induced by propylthiouracil therapy. Respiration 2002 69(5) 473. 

CO2 asphyxiation is not recommended since it can cause perivascular edema in the lungs or alveolar hemorrhage. 

Barnett, V.T., Bergmann, F., Humphrey, H., Chediak, J. (1992). Diffuse alveolar hemorrhage secondary to superwarfarin ingestion. Chest 102(4) 1301-2. 

Nicolls MR, Terada LS, Tuder RM, Prindiville SA, Schwarz MI. Diffuse alveolar hemorrhage with underlying pulmonary capillaritis in the retinoic acid syndrome. Am J Respir Crit Care Med 1998 158(4) 1302-5. 

Alveolar hemorrhage can occur with penicillamine, usually as part of a fife-threatening pulmonary-renal sjm-drome resembling Goodpasture s syndrome (59,60). 

On the basis of experience in one patient and 10 published case histories, the scleroderma-pulmonary-renal syndrome, a rare and usually fatal complication of systemic sclerosis, characterized by fulminant alveolar hemorrhage and rapidly progressive renal insufficiency, has been reviewed (204). In their patient penicillamine was continued, and the disease progressed. Five of the 11 patients in their review had been using penicillamine. 

Acute renal insufficiency together with diffuse alveolar hemorrhage and bilateral pulmonary infiltrates was suspected to have been caused by penicillamme (500 mg/day for 6 months) in a 34-year-old white woman, who took penicillamine for progressive systemic sclerosis (234). Because of disseminated intravascular coagulation, a biopsy was not made and the role of penicillamine remained uncertain. 

Three case reports from Belgium and France have illustrated the fact that rarely proliferative crescent-forming extracapillary glomerulonephritis and renal insufficiency can also occur (236,237). AH three patients had taken penicillamine for systemic sclerosis. Antimyeloperoxidase antineutrophil cjdoplasm antibodies were found in aU three one patient also had alveolar hemorrhage (that is Goodpasture s syndrome). 

A 49-year-old woman with systemic sclerosis, taking penicillamine 750 mg/day, developed a vasculitis, with an orbital pseudotumor and, 2 months later, fatal alveolar hemorrhage. She also had antinuclear antibodies with a homogeneous pattern. 

Aguilera CR, Garcia-De La Torre 1. Diffuse alveolar hemorrhage in limited cutaneous systemic sclerosis with positive perinuclear antineutrophil cytoplasmic antibodies. J Rheumatol 1996 23(10) 1821-3. 

Leatherman JW, Davies SF, Hoidal JR. Alveolar hemorrhage syndromes diffuse microvascirlar limg hemorrhage in immune and idiopathic disorders. Medicine (Baltimore) 1984 63(6) 343-61. 

Retinoic acid sjmdrome has been reported in a patient who developed diffuse alveolar hemorrhage while being treated with tretinoin for acute promyelocjhic leukemia (32). 

Raanani P, Segal E, Levi I, Bercowicz M, Berkenstat H, Avigdor A, Perel A, Ben-Bassat I. Diffuse alveolar hemorrhage in acute promyelocytic leukemia patients treated with ATRA—a manifestation of the basic disease or the treatment. Leuk Lymphoma 2000 37(5-6) 605-10. 

Nakajima H, Miyazaki M, Imai N, Yokokawa T, Yamamoto S. A case of silicosis with MPO-ANCA-associated glomerulonephritis and alveolar hemorrhage. Nippon Jinzo Gakkai Shi 2001 43 351-356. 

Respiratory effects have been observed in a munber of animal studies. In dogs, alveolar hemorrhage, emphysema, and atelectasis were observed following intermittent exposure to 25 ppm... 

Exposure to 750 mg m for 30 min did not cause mortalities. Animals sacrificed 1 day postexposure had minimal lung pathology (alveolar capillary congestion with a few alveolar hemorrhages). There was no histopathology in animals sacrificed at 10 and 28 days postexposure. 

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