Edema resident survival guide

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahmoud Sakr, M.D. [2]

Overview

Edema is abnormal collection of fluid in interstitial space whether hydrostatic interavascular pressure and permeability of vessel wall increase and colloid oncotic pressure of plasma decreases and lymphatic derenage is obstructed.

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

• The main complications of deep vein thrombosis are pulmonary embolism, postthrombotic syndrome, and recurrence of thrombosis. Proximal thrombi are a major source of morbidity and mortality. Distal thrombi are generally smaller and more difficult to detect noninvasively, and their prognosis and clinical importance are less clearacute pulmonary edema PMID: 28149030
• acute cerebral edema PMID: 26661240
• acute laryngeal edema doi:10.1001/archinte.161.5.714
• macular edema PMID: 30451174

Common Causes of peripheral edema

• • • Renal
      • (1) Advanced kidney disease of any cause
      • (2) Nephrotic syndrome PMID: 30697163
    • Cardiovascular
      • (1) Systolic or diastolic heart failure (HF)PMID: 22287864
      • (2) Constrictive pericarditis
      • (3) Pulmonary hypertension
  • Hematologic: anemia
    • GI :
    • Nutritional deficiency or malabsorption leading to hypoalbuminemia
    • (2) Refeeding edema
  • deep vein thrombosis PMID: 22287864
  • cellulitis
  • superficial thrombophlebitis
  • baker cyst
  • venous hypertension or chronic venous insufficiency including varicose veins, post thrombotic syndrome, lymphedema PMID: 31453511
  • hormons related such as pregnancy and menstrual cycle, hyperthyroidism PMID: 22935075. cushing disease
  • medications:
  • dihydropyridines calcium channel blocker amlipidine, nifedipine ,
  • escitalopram PMID: 24574569 .
  • Direct vasodilators (hydralazine, minoxidil,
  • non-steroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen or naproxen),
  • gabapentin, hormones (such as oral contraceptives),
  • prednisone,
  • thiazolidinediones (such as pioglitazone or rosiglitazone),
  • obesity

Diagnosis

Shown below is an algorithm summarizing the diagnosis of [[disease name]] according the the [...] guidelines.10.3122/jabfm.19.2.148

Edema

Generalized

Localized

JVP estimation

Normal JVP

Elevated JVP

serum albumin,urine protein

Checking thyroid function tests for finding myxedema

Checking thyroid function tests for finding myxedema

'PMID: 9753021

'PMID: 16513903

PMID: 31461980

PMID: 31348293

https://doi.org/10.1016/B978-0-323-04107-2.50011-9

central venous pressure by determining jugular venous pressure (JVP). The distance from the manubrium sterni to the fluid meniscus in the jugular vein should be ≤2 cm at 45 degrees or 5 cm from the left atrium.

Treatment

Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.

Treatment is specific to the etiology of the edema, but compression stockings, elevation, exercise, and weight loss remain the cornerstone in most cases.

leg elevation, compression therapy, exercise, weight loss, reduced dietary salt intake, and diuretics PMID: 24707668

Do's

• in proximal dvt , using compression bandage or medical compression stockings and walking accompanied with anticoagulant therapy will lessen the pain and swelling PMID: 11054217
• In DVT and SVT using medical compression will not increase the risk of pulmonary thromboembolism and post thrombotic syndrome. PMID:11054217, PMID: 29217387,PMID: 11204585, PMID: 18480967

• Early mobilization in acute deep vein thrombosis will not increase the risk of pulmonary thromboembolism PMID: 11204585
• in acute phase of DVT ,calf compression reduces irriversible skin signs, edema and pain PMID: 29856509
• in compensated heart failure NYHA । and ॥ , mild compression both legs may increase cardiac preload DOI:10.1002/ehf2.12848

Don'ts

• • do not use medical compression device in the conditions include:
  • severe prepheral arterial occlusive disease when ankle-brachial index (ABI)< 0.6, ankle pressure<60 mmHg, transcutaneous oxygen pressure<20 mmHg
  • suspected compression of bypassed arteries
  • severe decompensated heart failure (NYHA 4) because of increasing right arterial pressure leading to deterioration right and left ventricular function DOI:10.1002/ehf2.12848
  • history of allergic reaction to compression material
  • severe diabetic neuropathy with sensory loss, microangiopathy and risk of skin necrosis

References

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