A 20-year-old G1 at 18 weeks of gestation is hospitalized for intravenous antibiotics for the treatment of acute pyelonephritis. She develops shortness of breath and is found to have tachypnea and decreased oxygen saturation. Chest x-ray reveals pulmonary infiltrates consistent with pulmonary edema.
What is the most likely cause of this complication?
A. Acute renal failureEndotoxin release can cause alveolar injury and lead to pulmonary edema and acute respiratory distress. Endotoxin release can also cause renal dysfunction manifested as increase serum creatinine, but this effect is usually reversible with fluid resuscitation. Uterine contractions and hemolytic anemia are also effects of endotoxin release. Bacteremia can be found in up to 20% of women with pyelonephritis, but it is the endotoxin release that leads to alveolar damage. While allergic reactions to antibiotics can cause respiratory symptoms, they do so by causing bronchoconstriction. Intravenous hydration to ensure adequate urinary output (> 50 mL/h) is the mainstay of therapy. Careful monitoring of the input and output of the patient is necessary so that fluid overload will not compound the pulmonary effects of the endotoxin.