Children pulmonary edema

Numerous case studies have described death following the accidental ingestion of kerosene by children (usually under the age of 5 but as old 15 years). The deaths are usually attributed to lipoidal pneumonia (Morrison and Sprague 1976 Santhanakrishnan and Chithra 1978 Zucker et al. 1986) that was probably induced by the aspiration of the kerosene. Specific respiratory effects associated with death from kerosene ingestion include pneumothorax (Mahdi 1988 Zucker et al. 1986), emphysema (Mahdi 1988), and pneumonitis (Singh et al. 1981). Cardiac arrhythmia was reported as the cause of death in one child however, it was suspected that myocarditis and pulmonary edema may have been the cause of the rapid deterioration and death of the child (Dudin et al. 1991). 

The safety of gadobenate dimeglumine has been evaluated in 2367 adults aged 18-88 years and 173 children. The overall incidence of adverse events was 20%. Events related to the contrast agent were reported in 15 % of the adults. Most of the adverse events were mild and transient and resolved spontaneously. Headache, injection site reactions, nausea, taste disturbance, and vasodilatation were the most common, with frequencies of 1.0-2.6%. Serious adverse events potentially related to the contrast agent were reported in 0.2%. These events included laryngospasm, which developed 10 minutes after the contrast injection in a 51-year-old woman, severe vomiting in a 5-year-old child, and pulmonary edema in a 65-year-old patient. 

A child who underwent induction of anesthesia with halothane developed hiccups associated with pulmonary edema (17). 

An 8-year-old girl with a history of seizures and cerebral ischemic strokes secondary to moyamoya disease underwent anesthetic induction with halothane and 70% nitrous oxide. She had had three previous uneventful anesthetics. Hiccups started within seconds of induction of anesthesia and did not cease until 20 minutes later, when she was paralysed, intubated, and ventilated. During the next 20 minutes a period of hemodynamic instability ensued, with increasing oxygen requirements. The procedure was stopped and pulmonary edema was confirmed on chest X-ray. The child was transferred to the intensive care unit and ventilated overnight. Further recovery was uneventful. 

Hiccups during anesthesia are often thought to be benign. Negative pressure pulmonary edema is usually associated with an obstructed airway, as occurs with laryngospasm, or other causes of upper airway obstruction, but was presumably the cause in this child. 

Stuth EA, Stucke AG, Berens RJ. Negative-pressure pulmonary edema in a child with hiccups during induction. Anesthesiology 2000 93(l) 282-4. 

Unusually, a mother and her child died after repeated administration of a local anesthetic for cesarean section pulmonary edema was believed to have been the cause (122). 

It can never be emphasized enough that the eyes are a potential route for systemic drug administration. This has been illustrated by a British case of pulmonary edema in a child, apparently attributable to systemic absorption of phenylephrine eye-drops (1). 

A child developed cardiac dysrhythmias, severe hypertension, and pulmonary edema after the intraoperative administration of ocular phenylephrine (1). 

A 2-month-old child given perioperative phenylephrine drops during cataract extraction developed ventricular extra beats, very severe hypertension, and pulmonary edema requiring intensive therapy (5). Extubation was possible within 3 hours, and she recovered with no untoward consequences. 

Greher M, Hartmann T, Winkler M, Zimpfer M, Crabnor CM. Hypertension and pulmonary edema associated with subconjunctival phenylephrine in a 2-month-old child during cataract extraction. Anesthesiology 1998 88(5) 1394-6. 

For similar routes and forms of mercury, the adverse health effects seen in children are similar to the effects seen in adults. For example, a young child who was intoxicated with mercury vapor, died of pulmonary edema and had a grayish, necrotic mucosa of the stomach and duodenum (Campbell 1948). These effects are similar to those seen in adult populations occupationally exposures to inhaled metallic mercury vapors. Respiratory effects in adults from inhalation of metallic mercury vapor include pulmonary edema, lobar pneumonia, fibrosis, desquamation of the bronchiolar epithelium, and death in severe cases due to respiratory failure (Gore and Harding 1987 Jaffe et al. 1983 Kanluen and Gottlieb 1991 Matthes et al. 1958 Taueg et al. 1992 Teng and Brennan 1959 Tennant et al. 1961). 

In spite of an increased susceptibility to infections, the majority of affected children will survive into adulthood. We know of the death of only three patients, one of whom was the above mentioned patient of Sobrevilla et al. (1964) who died from an acute cardiac disturbance at the age of 37 years. The second is probably the patient of Friedman et al. (1960), according to a personal communication from Goldner to Schwartz et al. (1963). The third fatal case was that of an 18 month-old child (Becroft et al. 1965) who died from cardiac failure with pulmonary edema during an episode of bronchitis and asthma. 

Venkatakrishnan J, Jagadeesh V, Kannan R. Pulmonary edema following instillation of topical phenylephrine eyedrops in a child under... 

Abdelhalim AA, Mostafa M, Abdulmomen A, Othman EA. Severe hypertension and pulmonary edema associated with systemic absorption of topical phenylephrine in a child during retinal surgery. Saudi J Anaesth 2012 6(3) 285-8. 

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