Pulmonary Edema

Sonia S. Swart, MA, MRCP; Robert F. Bing, MB, ChB, MRCP; John D. Swales, MD
Arch Intern Med. 1981;141(10):1388. doi:10.1001/archinte.1981.00340100144037.
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To the Editor.  —A case of pulmonary edema with hypernatremia precipitated by voluntary ingestion of table salt occurred in a young woman with previously undiagnosed and asymptomatic mitral stenosis.

Report of a Case.  —A 29-year-old woman was admitted with a 24-hour history of progressively increasing breathlessness accompanied by copious pink sputum. There were no other symptoms or history of rheumatic fever. She was not taking any medication.She was pale, centrally cyanosed, tachypneic (respirations, 60/min), and pyrexial (38.7 °C), with a sinus tachycardia of 124 beats per minute. The blood pressure was 70/50 mm Hg. Jugular venous pressure was elevated 3 cm, with mild edema of the ankles and hands. Heart sounds 1 and 2 were normal, with a third heart sound but no murmurs or cardiomegaly. Fine crepitations were heard over both lung fields. Findings from investigations were as follows: an ECG showed anterolateral T-wave inversion ischemia with a


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