Anasarca

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Anasarca
CT scan showing generalized edema of skin
ICD-10 R60.1
ICD-9 782.3

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

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Synonyms and keywords: Generalized edema, generalized swelling, 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 Underlying Causes of Anasarca

(In alphabetical order)

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.

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