Edema fluid and a coagulation profile were obtained in 45 patients (17 to 87 years) during fulminant pulmonary edema. Left ventricular failure and/or volume overload accounted for edema in 18 patients. In another 27 patients, edema developed in association with other features that typify the adult respiratory distress syndrome (ARDS). In the ARDS group, multiple disorders were implicated in the genesis of edema, including shock, bacteremia, drug overdose, and aspiration. Assessment of edema fluid and coagulation measurements is useful to classify and to determine the severity of the edema process. ARDS is characterized by permeability pulmonary edema that usually stems from a combination of multisystemic disorders. Permeability pulmonary edema and coagulation changes appear to be interrelated. However, it is not clear the extent to which the coagulation disturbances are a cause or a result of the alterations in the alveolar-capillary membrane.