title: Acute lung injury after peppermint oil injection.
abstract: We describe a case of acute lung injury following IV injection of peppermint oil. An 18-yr-old woman injected the oil and developed fulminant pulmonary edema requiring ventilator support. Within 4 h after injection her arterial oxygen tension was 8.1 kPa (60 mm Hg) at an inspired oxygen fraction (F(IO2)) of 0.7 (P/F ratio: 85) despite a positive end expiratory pressure (PEEP) of 20 mbar, therefore meeting criteria for acute respiratory distress syndrome (ARDS). Mean pulmonary artery pressures and pulmonary artery wedge pressures were within normal limits throughout the case (<25 mm Hg and <10 mm Hg, respectively). Ventilation with high PEEP and diuresis resulted in a P/F ratio of 265 after 24 h. The patient was successfully weaned from the ventilator on the 9th day. This report is the first description of the sequelae of IV peppermint oil injection. The injection resulted in pulmonary edema and acute lung injury, presumably due to direct toxicity and a resultant increase in pulmonary vascular permeability.
  
  
  CONCLUSIONS
  This report is the first description of IV peppermint oil injection. The patient rapidly developed severe fluid overload of the lung and subsequent lung injury that required intubation, mechanical ventilation, and intensive care therapy for 13 days. The pulmonary edema was presumably caused by direct toxicity and an increase in pulmonary vascular permeability.
authors.affiliation: Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Essen, Essen, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Behrends
authors.forename: Martin
authors.initials: M
authors.lastname: Beiderlinden
authors.forename: Jürgen
authors.initials: J
authors.lastname: Peters
mesh_terms: D000293:Adolescent; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D036142:Mentha piperita; D010938:Plant Oils / Q000008:administration & dosage / Q000506:poisoning*; D011654:Pulmonary Edema / Q000139:chemically induced*; D012128:Respiratory Distress Syndrome / Q000139:chemically induced*
chemical_list: D010938:Plant Oils; C015424:peppermint oil