Dear Label_Name,

Greetings! I hope you are well.

I am writing on behalf of an international publishing house, Science and Education Publishing, USA (http://www.sciepub.com).

Science and Education Publishing (SciEP) is a multidisciplinary open access publisher of Journals covering the fields of Science, Technology and Medicine. All SciEP publications are subject to high-quality peer review, editorial and production processes and are freely available online.

Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
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American Journal of Medical Sciences and Medicine
American Journal of Medical and Biological Research
American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
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Journal of Cancer Research and Treatment
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Label_Title

Dear Label_Name,

Greetings! I hope you are well.

I am writing on behalf of an international publishing house, Science and Education Publishing, USA (http://www.sciepub.com).

Science and Education Publishing (SciEP) is a multidisciplinary open access publisher of Journals covering the fields of Science, Technology and Medicine. All SciEP publications are subject to high-quality peer review, editorial and production processes and are freely available online.

Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
American Journal of Public Health Research
American Journal of Medical Sciences and Medicine
American Journal of Medical and Biological Research
American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
American Journal of Hypertension Research
American Journal of Sports Science and Medicine
Journal of Cancer Research and Treatment
American Journal of Zoological Research
Journal of Biomedical Engineering and Technology
American Journal of Microbiological Research
Biomedical Science and Engineering

We are pleased to announce that submissions are now being accepted for peer review for all the journals across all our subject areas in SciEP.

Please submit your manuscript via our online submission system:
http://www.sciepub.com/author/signin

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I am looking forward to hearing from you.

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David Rain
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Science and Education Publishing (http://www.sciepub.com)

A Case of Pulmonary Edema Induced by Acute Alcoholic Intoxication

Chihiro Maekawa, Tatsuro Sakai, Hiroaki Taniguchi, Noriko Tanaka, Youichi Yanagawa*

Department of Acute Critical Care Medicine, Juntendo Shizuoka Hospital, Izunokuni, Japan

Abstract: A 31-year-old male with no medical history, who runs his own nightclub, experienced altered consciousness after heavy alcohol drinking and was transported to our hospital by ambulance. On arrival, he was in a deep coma with tongue base retraction and snoring respiration. Auscultation revealed wet rales in both lung fields, necessitating tracheal intubation. Whole-body computed tomography revealed left-dominant ground-glass opacities and infiltrative shadows in both lungs' dorsal regions. His heart function was normal. The patient was diagnosed with acute alcohol intoxication, bilateral pulmonary edema, and aspiration. His lung function improved without event, and he was discharged on the third day. This case showed rare pulmonary edema induced by acute alcohol intoxication. The mechanism of pulmonary edema might be due to impaired alveolar epithelium and alveolar macrophages, reduction in alveolar fluid clearance, fluid retention in the human body due to the direct effect of alcohol, and/or negative-pressure pulmonary edema caused by airway obstruction due to coma.

Keywords: alcohol, pulmonary edema, negative pressure

Received June 10, 2024; Revised July 14, 2024; Accepted July 21, 2024

Citation: Chihiro Maekawa, Tatsuro Sakai, Hiroaki Taniguchi, Noriko Tanaka, Youichi Yanagawa, A Case of Pulmonary Edema Induced by Acute Alcoholic Intoxication. American Journal of Medical Case Reports, 12 (7). 101-102. January 2024. doi:10.12691/ajmcr-12-7-3

1. Introduction

The increased consumption of soft drinks is associated with t Alcohol intoxication is a clinical diagnosis based on the presence of clinically significant problems and behavioral or psychological changes, accompanied by physiological signs of intoxication, including confusing language, incoordination, unstable gait, nystagmus, conjunctival injection, impaired attention or memory, stupor or coma. [1] The main life-threatening consequence of acute intoxication with high blood alcohol concentrations is respiratory depression. In these conditions, intoxication also reduces the sensitivity of the airways and the reflex block of foreign bodies, increasing the risk of aspiration. [1] While pulmonary edema induced by acute alcohol intoxication is rare, we present a case we experienced.

2. Case Report

A 31-year-old male with no medical history, who runs his own nightclub, experienced altered consciousness after consuming two cups of shochu and one 500 ml bottle of tequila in a single sitting, and was transported to our hospital by ambulance. On arrival, the patient's Glasgow Coma Scale was E1V1M1; blood pressure, 110/85 mmHg; heart rate, 90 beats per minute; respiratory rate, 24 breaths per minute; percutaneous saturation, 100%; and body temperature, 35.9°C. He was in a deep coma with tongue base retraction and snoring respiration, and auscultation revealed wet rales in both lung fields, necessitating tracheal intubation. A 12-lead electrocardiogram showed no significant abnormalities, and cardiac ultrasound indicated hyperdynamic wall movement. Whole-body computed tomography revealed left dominant ground-glass opacities and infiltrative shadows in both lungs' dorsal regions (Figure 1). The patient was diagnosed with acute alcohol intoxication, bilateral pulmonary edema, and aspiration, for which sulbactam and mechanical ventilation were administered. Results of arterial blood gas under 6 L per minute of oxygen via mask were pH 7.32, PCO₂ 52.3 mmHg, PO₂ 112.0 mmHg, HCO₃⁻ 26.2 mmol/L, base excess -0.6 mmol/L, and lactate 1.9 mmol/L. Calculated ethanol blood concentration based on the osmotic gap was 753 mg/dL. On the second hospital day, the patient regained consciousness and the ratio of arterial oxygen partial pressure to fractional inspired oxygen improved, leading to extubation. On the third hospital day, the patient was discharged as oxygen requirements ceased and the patient was able to walk and eat.

Figure 1. Chest computed tomography (CT) on arrival. The CT revealed left dominant ground-glass opacities and infiltrative shadows in both lungs' dorsal regions

3. Discussion

This is a rare pulmonary edema induced by acute alcoholic intoxication. Previous studies in relevant animal models as well as in human subjects are identifying common mechanisms by which alcohol abuse targets both the alveolar epithelium and the alveolar macrophage, such that the risks for acute lung injury and pulmonary infections are inextricably linked. [2] In addition, both acute and chronic ingestion of alcohol causes an increase in the systemic levels of extracellular adenosine via inhibition of the nucleoside transporter, which impairs the uptake of adenosine.3 Alcohol induces increases in lung adenosine levels, which may be responsible for reduction in alveolar fluid clearance and associated lung injury. [3] Accordingly, acute alcohol intoxication of itself might cause of pulmonary edema.

While, the present case showed initially upper airway obstruction due to deep coma. Negative-pressure pulmonary edema (NPPE) or post-obstructive pulmonary edema is a well-described cause of acute respiratory failure that occurs after intense inspiratory effort against an obstructed airway, usually from upper airway infection, tumor, or laryngospasm. [4] Previously, one report indicated negative pressure pulmonary edema associated with acute ethanol intoxication, similar to our findings. [5]

Alcohol might induce fluid retention in the human body in the early phase of drinking, which could exacerbate pulmonary edema in this case. [6] However, alcohol has a diuretic effect that not only resolves fluid retention but also leads to a dehydrated state in the late phase. [6] Therefore, the resolution of pulmonary edema in the acute phase of this case might be attributed not only to mechanical ventilation but also to the diuretic effect of alcohol.

4. Conclusion

This is a rare pulmonary edema induced by acute alcoholic intoxication. The mechanism of pulmonary edema might be induced by impaired alveolar epithelium and alveolar macrophages, reduction in alveolar fluid clearance, fluid retention in the human body due to the direct effect of alcohol, and/or negative-pressure pulmonary edema caused by airway obstruction due to coma.

ACKNOWLEDGEMENTS

This work was supported in part by a Grant-in-Aid for Special Research in Subsidies for ordinary expenses of private schools from The Promotion and Mutual Aid Corporation for Private Schools of Japan.

References

[1]   | D'Angelo A, Petrella C, Greco A, Ralli M, Vitali M, Giovagnoli R, De Persis S, Fiore M, Ceccanti M, Messina MP. Acute alcohol intoxication: a clinical overview. Clin Ter. 2022 May 25; 173(3): 280-291.
[2]   | Joshi PC, Guidot DM. The alcoholic lung: epidemiology, pathophysiology, and potential therapies. Am J Physiol Lung Cell Mol Physiol 292: L813–L823, 2007.
[3]   | Dada L, Gonzalez AR, Urich D, Soberanes S, Manghi TS, Chiarella SE, Chandel NS, Budinger GR, Mutlu GM. Alcohol worsens acute lung injury by inhibiting alveolar sodium transport through the adenosine A1 receptor. PLoS One. 2012; 7(1): e30448.
[4]   | Bhattacharya M, Kallet RH, Ware LB, Matthay MA. Negative-Pressure Pulmonary Edema. Chest. 2016 Oct; 150(4): 927-933.
[5]   | Nakayama S, Murashima N. A case of negative pressure pulmonary edema associated with acute ethanol intoxication. Intern Emerg Med. 2010 Apr; 5(2): 175-6.
[6]   | Flores-Salamanca R, Aragón-Vargas LF.Postexercise rehydration with beer impairs fluid retention, reaction time, and balance.Appl Physiol Nutr Metab. 2014 Oct; 39(10): 1175-81.