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 an abnormal collection of fluid in interstitial space because of an imbalance in hydrostatic pressure, oncotic pressure, increased capillary permeability, and obstruction in lymphatic drainage.
Causes
Life Threatening Causes
Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.
- Generalized edema caused by decompensated heart failure
- Unilateraledema caused by proximal deep vein thrombosis leading acute pulmonary embolism
Common Causes of peripheral edema
- Renal
- Advanced kidney disease
- Nephrotic syndrome PMID: 30697163
- Cardiovascular
- Systolic or diastolicheart failure (HF)PMID: 22287864
- Constrictive pericarditis
- Pulmonary hypertension
- Renal
- Deep vein thrombosis PMID: 22287864
- Cellulitis
- Superficial thrombophlebitis
- Baker cyst
- chronic venous insufficiency
- lymphedema PMID: 31453511
- Hormons
- pregnancy
- menstrual cycle
- hypothyroidism PMID: 22935075.
- cushing disease
- Medications
- Obstructive sleep apnea
Diagnosis
Shown below is an algorithm summarizing the diagnosis of [[disease name]] according the the [...] guidelines.10.3122/jabfm.19.2.148
| Associated injury/illness | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Recent surgery/procedure | Malygnancy | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Painful | History | Onset(acute,chronic) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Aggravated by activity | Underlying illness | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Change in medications | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Pulse examination | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Ulcer | lymphadenopathy/masses | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Pitting | Physical examination | Unilateral/bilateral | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Skin condition,texture,color | Distribution | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Temperature | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
- ❑ Monoamine oxidase inhibitors, trazodone
- ❑ Beta-adrenergic blockers,dihydropyridine calcium channel blockers, clonidine , hydralazine, methyldopa, minoxidil
- ❑ Acyclovir
- ❑ Cyclophosphamide, cyclosporine (Sandimmune), cytosine arabinoside, mithramycin
- ❑ Androgen, corticosteroids, estrogen, progesterone, testosterone
- ❑ Celecoxib, ibuprofen
- ❑ Pioglitazone,roziglotazone
- ❑ Levofloxacin
- ❑ Citalopram
- ❑ Complete blood count
- ❑ Urinalysis
- ❑ Blood sugar
- ❑ Creatinine
- ❑ Thyroid-stimulating hormone
- ❑ Serum Albumin
- ❑ D-dimer
- ❑ BNP
- ❑ AST
- ❑ ALT
- ❑ Total Bilirubin
- ❑ Prothrombin time
- ❑ Alkaline phosphatase
Treatment
Shown below is an algorithm summarizing the treatment of [[disease name]] according to 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
- Before initiation of medical compression therapy, checking the arterial circulation is recommended. if foot pulse or ankle pulse is weak or not palpable, the ankle-brachial index(ABI) should be measured.
- 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 the acute phase of DVT, calf compression reduces irreversible skin signs, edema, and pain PMID: 29856509
- In compensated heart failure NYHA । and ॥, mild compression of both legs may increase cardiac preload DOI:10.1002/ehf2.12848 Corpus ID: 68752450
- correction the sizing of compression therapy is recommended in diabetic neuropathy for prevention of peripheral nerve damage especially peroneal nerve palsy and foot drop.https://doi.org/10.3928/0147-7447-20001001-29 https://doi.org/10.3928/0147-7447-20001001-29 https://doi.org/10.1111/j.1365-2133.2004.06010.x
- obstructive sleep apnea in obese patients may cause bilateral leg edema due to pulmonary hypertension induced by hypoxia doi:10.1001/archinte.160.15.2357
- after harvesting of leg veins for bypass graft surgery, mild compression stocking about 15-20 mmHg, reduced leg edema significantly. PMID: 25478535 . https://doi.org/10.4081/vl.2016.5989
Don'ts
- Do not use medical compression device in the conditions include:
- Severe peripheral arterial occlusive disease when the ankle-brachial index (ABI)< 0.6, ankle pressure<60 mmHg, transcutaneous oxygen pressure<20 mmHg
- Suspected compression of epifacial 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 an allergic reaction to compression material
- Severe diabetic neuropathy with sensory loss, microangiopathy, and risk of skin necrosis