Pulmonary Oedema, Acute
Description Emergency Treatment Referral ICD-10 code: J81 DESCRIPTION A life-threatening condition with abnormal accumulation of fluid in the lungs. Common causes include acute heart failure and acute renal failure (e.g. acute nephritis). Persons with pulmonary oedema may present similarly to acute bronchospasm. It is important to distinguish this condition from an acute attack of asthma. EMERGEN
ICD-10 code: J81
DESCRIPTION
A life-threatening condition with abnormal accumulation of fluid in the lungs.
Common causes include acute heart failure and acute renal failure (e.g. acute nephritis).
Persons with pulmonary oedema may present similarly to acute bronchospasm.
It is important to distinguish this condition from an acute attack of asthma.
EMERGENCY TREATMENT
Place the patient in a sitting or Semi-Fowler’s position.
Children
- Oxygen, using a 40% face mask or nasal cannula at 2–3 L/ minute.
- Furosemide, IV, 1 mg/kg immediately administered slowly over 5 minutes. See: Dosing table.
- Do not put up a drip or run in any IV fluids.
Adults
- Oxygen, using face mask to deliver 40% oxygen at a rate of 6–8 L/ minute.
AND
- Furosemide, slow IV, 40 mg.
If response is adequate follow with:
- Furosemide, IV, 40 mg in 2–4 hours.
If no response within 20–30 minutes:
- Furosemide, IV, 80 mg.
AND
- Isosorbide dinitrate, sublingual, 5 mg immediately.
- If needed, repeat every 5-10 minutes.
- Do not administer if hypotensive. Monitor BP.
CAUTION
Do not use morphine for pulmonary oedema, as there is observational data providing a signal of harm.
Pulmonary oedema due to a hypertensive crisis:
To treat hypertension:
ICD-10 code: I10
ADD
- ACE-inhibitor, e.g.
- Enalapril 10 mg, oral, as a single dose and refer.
REFERRAL
Urgent
All cases.
(Continue oxygen during transfer).
Click here for the Morphine Pulmonary Oedema PHC/Adult Hospital Review May 2022.
Click here for the NEMLC Recommendations for medicine amendments (2020-4 review cycle).
Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-4_Version 1.1_October 2024
Chapter 21: Emergencies and Injuries