Tuberc Respir Dis > Volume 44(1); 1997 > Article
Tuberculosis and Respiratory Diseases 1997;44(1):183-190.
DOI:    Published online February 1, 1997.
A case of Tocolytics Induced Pulmonary Edema.
Dae Jun Lee, Chang In Kim, Young Goo Jee, Kye Young Lee, Keun Yeol Kim, Young Hi Choi, Pil Weon Seo
1Department of Internal Medicine, College of Medicine, Dankook University, Chunan, Korea.
2Department of Radiology, College of Medicine, Dankook University, Chunan, Korea.
3Department of Chest Surgery, College of Medicine, Dankook University, Chunan, Korea.
Tocolytics are agents widely used in the treatment of premature labor to inhibit uterine contractions. Ritodrine is most commonly used tocolytic agent and acts by increasing intracellular cyclic adenosine monophosphate, which decreases the activity of myosin light-chain kinase, the rate-limiting enzyme in the signal network leading to contraction. Physiologic effects associated with the use of ritodrine are due to their effect on beta-1 as well as beta-2 receptors. Some of material complications o? therapy are tachycardia, hyperglycemia, hypokalemia, lactic acidosis, myocardial ischemia, and pulmonary edema. Tocolytic induced pulmonary edema is a serious complication that can lead to marternal death, although infrequent. The incidence varies from 0.5% to 5% of those receiving these agents. Predisposing factors include the concommitant use of corticosteroid, twin gestation, fluid overload(particularly with saline), and anemia. Several mechanisms have been postulated, but the pathogenesis is uncertain. It is suggested that both types of mechanism, hydrostatic and Permeability induced, might be involved. The association of tocolytic therapy with pulmonary edema appears to be unique to the pregnant state, because this complication has never been reported in asthmatic patients exposed to high dosages. We report a case of tocolytic induced pulmonary edema developed in 24 hours after delivery.

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