Unilateral pulmonary changes in acute respiratory distress syndrome of the adult

Abstract

A case report and review of the literature concerning the unilateral expression of acute respiratory distress syndrome in a previously healthy patient who had taken an overdose of sedation. A 23-year-old female was brought to the emergency room having taken an overdose of sedation (Tuinal and amphetamines). She was unresponsive to painful stimuli. The blood pressure was 100/70 mm Hg and the pulse was 72/min. Pupils were equal in size and non-responsive to light. Examination of the heart, lungs and abdomen was normal. A few hours after admission she developed irregular respirations and short periods of apnoea which required endotracheal intubation and a volume limited ventilator. A portable chest film at this time was normal (Fig. 1). Although the patient was not hypoxic, initial arterial blood gas analysis (ABG) was 92.4 with an inspired oxygen fraction (Fi 02) of 0.4. The arterial oxygen gradient at this time was 148 mm Hg (normal 40). A mild metabolic acidosis was noted.