Edema is a medical condition characterized by the accumulation of excess fluid in the tissues, resulting in swelling and discomfort. It can be caused by a variety of underlying medical conditions, including heart failure, liver disease, kidney disease, and certain medications.
When approaching a patient with edema, the first step is to obtain a detailed medical history and perform a physical examination. The medical history should include information about the onset and duration of symptoms, any recent changes in medication, and any underlying medical conditions. The physical examination should include a thorough evaluation of the affected area, including measurements of the degree of swelling.
Laboratory tests may also be performed to help identify the underlying cause of the edema. These may include blood tests to evaluate kidney and liver function, electrolyte levels, and thyroid function. Urine tests may also be performed to evaluate kidney function.
The treatment of edema depends on the underlying cause. For example, if the edema is caused by heart failure, treatment may include medications to improve heart function and reduce fluid retention, as well as lifestyle modifications such as a low-salt diet and increased physical activity. If the edema is caused by kidney disease, treatment may include medications to improve kidney function and reduce fluid retention.
In some cases, the use of compression garments or elevation of the affected area may be helpful in reducing edema. Diuretics, which are medications that increase urine output, may also be used to reduce fluid retention.
Overall, the approach to edema involves a comprehensive evaluation to identify the underlying cause and determine the most appropriate treatment plan. With proper management, many cases of edema can be effectively treated and controlled.
3. Definition of Edema
• Soft tissue swelling due to abnormal
expansion of interstitial fluid volume.
• Edema fluid is a plasma transudate that
accumulates when movement of fluid from
vascular to interstitial space is favored.
• Since detectable generalized edema in the
adult reflects a gain of 3L, renal retention of
salt and water is necessary for edema to
occur.
• Distribution of edema can be an important
guide to cause.
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7. Edema formation occurs when?
• An increase in capillary hydrostatic pressure (for example, increased
plasma volume due to renal sodium retention).
• An increase in capillary permeability (for example, burns,
angioedema).
• An increase in interstitial oncotic pressure (for example, myxedema).
• A decrease in plasma oncotic pressure (for example,
hypoalbuminemia).
• Lymphatic obstruction.
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24. Treatment
• Primary management is to identify and treat the underlying cause of edema
• Dietary Na restriction (500 mg/d) may prevent further edema formation.
• Bed rest enhances response to salt restriction in CHF and cirrhosis. Supportive stockings
and elevation of edematous lower extremities will help mobilize interstitial fluid.
• If severe hyponatremia (132 mmol/L) is present,water intake should also be reduced
(1500 mL/d).
• Diuretics are indicated for marked peripheral edema, pulmonary edema, CHF, inadequate
dietary salt restriction.
• Weight loss by diuretics shouldbe limited to 1–1.5 kg/d. Distal (“potassium sparing”)
diuretics or metolazone may be added to loop diuretics for enhanced effect.
• Note that intestinal edema may impair absorption of oral diuretics and reduce
effectiveness. When desired weight is achieved, diuretic doses should be reduced.
• In CHF,avoid overdiuresis because it may bring a fall in cardiac output and prerenal
azotemia. Avoid diuretic-induced hypokalemia, which predisposes to digitalis toxicity.
