Factitial Pulmonary Edema

To the Editor.— A recent experience at this hospital prompts recognition of an additional cause of noncardiac pulmonary edema. A 42-year-old woman was brought to the emergency room after she was found in the street obtunded, with labored respirations. Her blood pressure was 130/90 mm Hg; pulse rate, 110 beats per minute; temperature, 36.6 C; and respiration, 30/min, with peripheral cyanosis and frothy pink sputum. There was no jugular venous distension, and auscultation of the chest disclosed coarse breath sounds with both rales and rhonchi. Heart sounds were normal and there was no gallop. Other results of the examination were normal except for the patient's obtunded mental state. Arterial blood gas values with the patient breathing room air disclosed pH, 7.52; Po 2 , 44 mm Hg; and Pco 2 , 28 mm Hg. Chest roentgenograms showed bilateral, fluffy perihilar infiltrates. The electrocardiogram was within normal limits except for sinus tachycardia. The