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Flash pulmonary edema, also termed acute onset pulmonary edema, is characterized by the sudden onset of respiratory distress related to accumulation of fluid in the lung interstitium over a matter of minutes or hours. Chronic kidney disease is often associated with predisposing cardiac risk factors that make patients susceptible to development of flash pulmonary edema. This article highlights the connection between cardiac pathologies found in chronic kidney disease and development of flash pulmonary edema. Nephrology nurses may be instrumental in reducing the risk of flash pulmonary edema by recognizing symptoms of heart failure and need for treatment of acute elevations in blood pressure.
Goal
Recognize the risk for development of flash pulmonary edema in patients with chronic kidney disease and ESRD.
Objectives
1. Identify causes of flash pulmonary edema that may occur in conjunction with chronic kidney disease and ESRD
2. Recognize signs and symptoms of flash pulmonary edema.
3. Describe nursing measures that may avert development of flash pulmonary edema in individuals with advanced chronic kidney disease.
Flash pulmonary edema and acute pulmonary edema are terms used to define the sudden development of respiratory distress related to the rapid accumulation of fluid within the lung interstitium secondary to elevated cardiac filling pressures (Little, & Braunwald, 1997). For the purposes of this review, flash pulmonary edema will be the term used. One of the first studies to describe its occurrence linked its development to individuals with preexisting coronary artery disease and hypertension (Lee, Cabin, & Francis, 1988). The connection between flash pulmonary edema and kidney disease was initially described in individuals with bilateral renal artery stenosis (Pickering et al., 1988). This association has been so well characterized that the recommendation has been made that anyone presenting with flash pulmonary edema be considered for evaluation for renal artery stenosis (Missouris, Belli, & MacGregor, 2000).
The risk for flash pulmonary edema in individuals with chronic kidney disease (CKD), primarily end stage renal disease (ESRD), has been under emphasized in the literature. There are several possible explanations for the lack of reports describing an association between flash pulmonary edema and CKD, especially in patients with CKD receiving maintenance dialysis. The sudden onset of pulmonary edema may be assumed to be from excessive interdialytic weight gain, inaccurate dry...