Pleural effusion intravenous

A 78-year-old man became short of breath. He had been taking rosiglitazone 8 mg/day for 6 months. He had renal insufficiency, atrial fibrillation, hypertension, and congestive heart failure, with pitting edema and bilateral pleural effusions. He was refractory to intravenous furosemide and metolazone. Withdrawal of rosiglitazone and administration of bumetanide gave a net fluid output of 9.5 litres and the edema resolved. 

A 35-year-old woman with idiopathic thrombocytopenic purpura treated with high dosages of intravenous immunoglobulin developed a recurrent lymphocytic pleural effusion (53). 

Bolanos-Meade J, Keung YK, Cobos E. Recurrent lymphocytic pleural effusion after intravenous immunoglobulin. Am J Hematol 1999 60(3) 248-9. 

Ten days later she developed a persistent fever. A chest X-ray and a CT scan showed bilateral pleural effusions and interstitial infiltrates, but no pulmonary embolus. Tretinoin was withdrawn and she was given intravenous dexamethasone 10 mg every 12 hours. Her fever disappeared within 24 hours and her respiratory distress gradually improved during the next 24-48 hours. A chest X-ray 7 days later showed total resolution. 

Pulmonary edema and pleural effusions have been reported following intravenous injection in experimental animals. 

Care of the patient receiving an antineoplastic drug depends on factors such as the drug or combination of dru given, the dos e of the dru, tlie route of administration, the patient s physical response to tlierapy, the response of the tumor to chemotlierapy, and tlie type and severity of adverse reactions. Some dru may be administered by various rout, depending on tlie cancer being treated. Fbr example tliiotepa may be administered by the intravenous route for breast cancer, intravesical route for superficial bladder cancer, intrapleural route for malignant pleural effusions, and by tlie intraperitoneal route for ovarian cancer. 

Intravenous morphine for the management of cancer pain is feared owing to the risk of respiratory depression, especially in opioid-naive patients, or in patients with comorbidities such as pulmonary metastases, pleural effusions, pulmonary embohsm, and chronic obstructive lung disease. However, there is a low risk of respiratory depression if dosage titration is carried out carefully [31 ]. 

Pleural Effusion. The basic indication for drainage of pleural fluid collections is dyspnea in patients with malignant pleural effusions, while benign parapneumonic effusions are drained only exceptionally. Thoracocentesis can be performed with a small intravenous cannula as a temporary solution, or a small drainage catheter (8 French) using either the Seldinger or Trocar technique. The drainage catheter is connected to a three-way-stop-cock and a sterile evacuated bottle that drains the effusion continuously. 

Respiratory Dyspnea, cough, and broncho-spasm have been reported during intravenous immunoglobulin treatment. Rare adverse effects include pleural effusion, pulmonary edema, and TRALI [1, 53 , 54", 61 ]. 

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