Anasarca

Anasarca
ICD-10	R60.1
ICD-9	782.3

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Synonyms and keywords: Generalized edema, leucophlegmatia

Overview

Anasarca is a medical symptom characterized by widespread swelling of the skin due to effusion of fluid into the extracellular space. Anasarca is often due to either congestive cardiac failure, liver failure (cirrhosis of the liver), renal failure/disease, or the other diseases listed below. Plant-derived anticancer chemotherapeutic agents, such as docetaxel, cause anasarca through a poorly understood capillary leak syndrome.

Complete Differential Diagnosis of the Causes of Anasarca:

(In alphabetical order)

• Acute renal failure, especially oliguric renal failure with fluid retention
• Allergic reactions, only systemic severe allergic reactions with associated capillary leak
• Angioedema, rarely, when it is severe and generalized
• Burns (generalized severe burns can result in Hypoalbuminemia and capillary leak)
• Calcium channel blockers usually cause localized edma and not anasarca
• Capillary leak syndrome
• Cardiac tamponade resulting in heart failure and generalized edema
• Chronic kidney disease (advanced stages with fluid retention)
• Constrictive pericarditis with associated heart failure
• Cor pulmonale resulting in right heart failure
• Diazoxide usually cause localized edma and not anasarca
• Corticosteriods
• Dilated cardiomyopathy
• Docetaxel usually cause localized edma and not anasarca
• Eclampsia (severe eclampsia)
• Effusive-constrictive pericarditis with associated heart failure
• Estrogens
• Fludrocortisone
• Glomerulonephritis
• Haemolytic disease of the newborn
• Heart failure
• Hepatic cirrhosis
  • Alcoholic liver disease
  • Alpha-1-antitrypsin deficiency
  • Autoimmune hepatitis
  • Chronic hepatitis B
  • Chronic hepatitis C
  • Hepatic venous obstruction
  • Hereditary hemochromatosis
  • Primary biliary cirrhosis
  • Primary sclerosing cholangitis
  • Nonalcoholic fatty liver disease
  • Wilson's disease
• Hereditary angioedema in severe cases
• Hypertrophic cardiomyopathy
• Hypoalbuminemia
• Hypoproteinemia
• Hypothyroidism (advanced untreated hypothyroidism)
• Idiopathic edema
• Increased capillary permeability
• Increased interstitial oncotic pressure
• Interleukin-2 therapy
• Kwashiorkor
• Lymphatic obstruction usually cause localized limb edema unless very proximal
• Malnutrition
• Malignant ascites is usually associated with lower extremities edema
• Minoxidil usually causes localized edema to the lower extremities
• Nephrotic syndrome
• Nonsteroidal antiinflammatory drug causes localized edma
• Ovarian hyperstimulation syndrome
• POEMS syndrome
• Portal thrombosis causes lower extremities edema
• Pramipexole
• Pregnancy
• Protein loss
• Protein-losing enteropathy
• Reduced albumin synthesis
• Refeeding edema
• Restrictive cardiomyopathy
• Severe inflammation or sepsis 
• Sodium overload
• Thiazolidinediones
• Trauma (severe trauma)
• Tricuspid stenosis
• Tropical sprue
• Venous obstruction usually causes localized edema in the limb
• Water overload
• Yellow nail syndrome

Complete Differential Diagnosis of the Causes of Anasarca:

(By organ system)

Cardiovascular	Cardiac tamponade , Constrictive pericarditis, Cor pulmonale, Dilated cardiomyopathy, Effusive-constrictive pericarditis, Heart failure, Hypertrophic cardiomyopathy, Restrictive cardiomyopathy, Tricuspid stenosis
Chemical / poisoning	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	Calcium channel blockers, Diazoxide, Docetaxel, Estrogens Fludrocortisone, Interleukin-2 therapy, Minoxidil, Nonsteroidal antiinflammatory drugs, Corticosteriods
Ear Nose Throat	No underlying causes
Endocrine	Corticosteriods
Environmental	Water intoxication
Gastroenterologic	Alcoholic liver disease , Autoimmune hepatitis, Chronic hepatitis B, Chronic hepatitis C, Hepatic cirrhosis, Hepatic venous obstruction, Hereditary hemochromatosis, Portal thrombosis, Primary biliary cirrhosis, Primary sclerosing cholangitis, Wilson's disease
Genetic	Angioedema, Alpha-1-antitrypsin deficiency, Hereditary angioedema Hereditary hemochromatosis, Hypertrophic cardiomyopathy, Wilson's disease, Yellow nail syndrome
Hematologic	No underlying causes
Iatrogenic	Water intoxication, excess intravenous fluids
Infectious Disease	Tropical sprue
Musculoskeletal / Ortho	No underlying causes
Neurologic	No underlying causes
Nutritional / Metabolic	Hypoalbuminemia, Hypoproteinaemia, Kwashiorkor, Malnutrition Protein loss, Protein-losing enteropathy, Reduced albumin synthesis, Refeeding edema, Sodium overload, Tropical sprue, Water overload
Obstetric/Gynecologic	Eclampsia, Estrogens, Haemolytic disease of the newborn, Ovarian hyperstimulation syndrome, Pregnancy
Oncologic	Malignant ascites
Opthalmologic	No underlying causes
Overdose / Toxicity	Water intoxication
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal / Electrolyte	Nephrotic syndrome
Rheum / Immune / Allergy	Haemolytic disease of the newborn, Autoimmune hepatitis
Sexual	No underlying causes
Trauma	Trauma
Urologic	No underlying causes
Miscellaneous	No underlying causes

Treatment

The treatment of anasraca depends on the underlying cause. It involves the use of diuretics in cases related to heart failure or kidney disease. The latter may require hemodialysis especially if there are signs or symptoms of uremia. In cases of severe burns resulting in hypoalbuminemia and capillary leak, admission to a burn unit, volume and electrolyte replacement, and adequate nutrition is of paramount. Withdrawal of the offending drug is critical in drug-induced anasarca. The use of diuretics, paracentesis, and adequate nutritional supplementation is needed in anasarca secondary to hepatic cirrhosis. Profound hypothyroidism requires thyroid hormone replacement. Protein malabsorption syndromes require the identification of the underlying disease process and adequate protein supplementation.