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To the Editor:—
In the article "Pulmonary Aspiration of Gastric Acid: Mendelson's Syndrome: Successful Treatment with Lyophilized Urea and Ten Per Cent Invert Sugar" (JAMA79:900 [March 17] 1962), there was no direct evidence of aspiration of gastric contents. The more likely explanation of the massive "froth" and pulmonary infiltration was prolonged, partial upper-respiratory obstruction to inspiration. Positive pressure inhalation is not a reliable therapeutic test of the diagnosis of pulmonary edema since it commonly fails to reduce the "amount of froth" unless accompanied by the vaporization of an alcohol or detergent.The administration of lyophilized urea in 10% invert sugar dramatically improved the pulmonary condition at the expense of severe dehydration and a temperature of 108° F. (42.22° C.). The consequent hyperosmolarity of plasma could explain the response of the pulmonary infiltration if it were edema but not the chemical, exudative pneumonitis assumed by the author. His disapprobation
Berkowitz S. Pulmonary Aspiration of Gastric Acid. JAMA. 1962;182(1):95–96. doi:10.1001/jama.1962.03050400097024
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