Over the last several weeks, we have been discussing the situation of having fluids accumulating in different parts of the body. Today, we shall be discussing the above topic, a medical condition known as pulmonary oedema. This is the situation that occurs when fluids or just water settles within the air sacs of the lungs, thereby making it difficult or even impossible to breathe. The air prevents the exchange of carbon dioxide for oxygen within the lungs without which the blood soon becomes a poison with the accumulation of various toxins in it and the person dies. The cause of that immediate death is called respiratory failure, a failure of the normal breathing process that we just take for granted. Indeed, nearly all of us reading this article are probably unaware that we are even breathing. Yet, without that very necessary activity, life, as we know it, will simply cease to be.
As with the other conditions we have discussed lately, this situation can happen suddenly or it can build up over time. The former is described as an acute condition while the latter is known as chronic. Without adequate and timely intervention, either one of them can cause death.
When this condition is acute in onset, therefore, it is an emergency. Death can occur swiftly without the required emergency treatment. It is a situation that can suddenly occur without prior warning with features like difficulty with breathing such that the person becomes aware that they are struggling to breathe; there is a feeling of suffocation; a sensation of an impending catastrophe; chest pain; cough that produces whitish phlegm but sometimes a pinkish one as well with air bubbles, and lastly, restlessness and anxiety. The person may also begin to breathe with a musical note called wheezing and sweat in excess. However, when pulmonary oedema builds up slowly over some time, there could be weight gain just as we saw happen in the case of fluid accumulation around the body. There will also be fatigue and situations when the person suddenly wakes up during the night essentially and find themselves gasping for air. Over time, there is an increased level of breathlessness with any little activity such as a short walk from the bedroom to the toilet. Swelling of the feet and ankles can ensue.
One of the most terrifying situations one sees in this condition is the occurrence of poor sleep while lying down on a bed or any other surface. Usually, it progressively becomes impossible to lie flat or even with the use of a single pillow. These patients will have to use multiple pillows, sometimes as many as three or four such that they will end up sleeping in a position almost as though they were sitting up in bed. This malady can be the complication of a failure of the circulatory system such that the pumping of blood around the body becomes inefficient thus causing too much fluid to accumulate around the body including the lungs, or when there has been a near-drowning situation in which people inhale water. Chest injuries with lung damage can also cause blood to flood the lungs and cause a similar outcome just as infections such as pneumonia and sepsis can cause similar complications. We have discussed sepsis during the last couple of years on this page. Heart failure, kidney failure, and liver failure also will encourage fluids to accumulate within the lungs thereby leading to the development of any of the conditions described in the second paragraph above.
When people who live along the coastal areas of Nigeria are suddenly relocated to places such as the Adamawa mountains, or Chabal Waade in Taraba State near the border with Cameroun, they can also develop this kind of condition as a feature of adaptation to a high altitude environment. This has to do with the fact that the small vessels in the lungs, the capillaries, become so squeezed up that they force fluids into the lungs and cause them to flood. This simulates a drowning situation and can be fatal without emergency treatment. Inside the hospital, this kind of disaster can also occur when the system is overloaded with drips. It can result from a sudden increase in the blood pressure in somebody who was already on treatment for that condition, thereby causing a sudden increase in the pressure within the heart due to its inability to overcome the resistance within the blood vessels. With this condition, the effectiveness of the heart as a pump diminishes greatly and might even fail so that fluids then build up within the lungs and the body as a whole. This is a situation that can be avoided by the regular use of prescribed medicines including the presence of mind to take them along with you even if one is travelling.
Sadly, due to the menace of kidnapping around the country these days, some of the people who belong to these medical situations are suddenly denied access to their medications and some inevitably die in captivity. And so as part of the sensible preventive steps one must take would be to also hide some tablets away inside pockets. Other survival mechanisms must include deliberate efforts to be introduced slowly to high elevations like the Chabal Waade range, with adequate periods of rest built into the climb. The mountain is also called the mountain of death, and it is not for nothing that it bears that name. In our diet, it is important to cut down on the amount of salt taken in the meals especially in the soup and stew because excess salt in the body can lead to the retention of water which in turn increases the amount of work the heart does has to do. In the same way, the amount of cholesterol in the system must be controlled adequately because it can cause heart disease when the level is too high and cause fluids to accumulate within the lungs. The heart, its vessels and the lungs can similarly get damaged by heavy cigarette smoking and people must desist from that.
The treatment of this condition must be approached with the seriousness it deserves. Apart from the basic preventive measures described in the chapter above, the treatment of this condition has to depend on treating the underlying cause. If there is pneumonia or some other precipitating sepsis, it should be treated promptly with suitable antibiotics by a qualified healthcare professional once that diagnosis is made. If the kidneys are failing or it is the heart or liver that is sick and not performing well, those organs must first be treated appropriately so that the lungs can be rescued. If there is severe hypertension, there must be treatment instituted with appropriate medications which should be used regularly. Some of these drugs are known as diuretics, which work by helping the body get rid of excess fluids. The result of this usage is that more urine is produced and the frequency of urination therefore increases. That is only a temporary inconvenience and will be stopped when there is no longer a need for the use of such medicines. As for those whose kidneys are failing already or have failed, there is no way to get rid of the excess fluids except by dialysis.
