Tuberc Respir Dis.  1997 Feb;44(1):183-190.

A case of Tocolytics Induced Pulmonary Edema

• Lee DJ
• Kim CI
• Jee YG
• Lee KY
• Kim KY
• Choi YH
• Seo PW

Abstract

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.

MeSH Terms

Acidosis, Lactic
Adenosine Monophosphate
Anemia
Causality
Female
Humans
Hyperglycemia
Hypokalemia
Incidence
Myocardial Ischemia
Myosins
Obstetric Labor, Premature
Permeability
Phosphotransferases
Pregnancy
Pulmonary Edema*
Ritodrine
Tachycardia
Tocolysis
Tocolytic Agents*
Twins
Uterine Contraction
Adenosine Monophosphate
Myosins
Phosphotransferases
Ritodrine
Tocolytic Agents