A Rare Case of Intraoperative Pulmonary Oedema Due to Hypoproteinaemia: A Case Report

Abstract

Pulmonary oedema may complicate the perioperative period and the aetiology may be different from non-operative patients. Broadly pulmonary oedema is classified as Cardiogenic 1 and non-cardiogenic. 2 There are many different and varied reasons for non cardiogenidc perioperative pulmonary oedema including high altitude, 3 neurogenic 4 causes, hypoproteinaemia being one of them. Diagnosis may be difficult during anaesthesia and consequently management may be delayed. A careful preoperative assessment to detect hypoalbumineamia in relevant cases may be necessary to expect a complication of such cause and to take steps to prevent and treat. A case is presented here which presented as Chronic intestinal obstruction with marked nutritional imbalance and anasarca, posted for laprotomy under general anaesthesia. Intraoperatively she developed pulmonary oedema which subsequently was managed successfully. KEYWORDS: Hypoproteinemia, hypoalbunimaemia, malnutrition, pulmonary oedema. INTRODUCTION:Marked reductions in the circulating levels of proteins, especially albumin, as a cause of Intraoperative pulmonary oedema that relates to intravascular factors is a known entity. Hypoproteinemia may result from rapid loss of proteins across a compromised glomerular barrier in diseased kidneys, impaired hepatic synthesis of plasma proteins in liver disease, severe malnutrition or protein-losing enteropathy (Which limits the availability of substrate for protein synthesis) , or from infusion of intravenous fluids lacking macromolecules. The ensuing reduction in the colloid osmotic pressure gradient, which favours reabsorption in the non-steady state and opposes the hydrostatic pressure gradient that favours filtration, induced by hypoproteinemia can result in a large transcapillary flux of protein-poor fluid into the interstitial spaces.Hypoproteinemia as a cause of perioperative pulmonary oedema, though rare is one of the cause. The other common non cardiogenic causes under anesthesia being neurogenic pulmonary oedema, negative pressure pulmonary oedema hypoxia and anaphylaxis as a cause are more frequently related to pulmonary oedema.