Anasarca patient information

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mydah Sajid, MD[2]

Overview

Anasarca is the presence of excess fluid in the interstitial space throughout the body.

What are the symptoms of Anasarca

The following questions should be asked to the patient regarding edema.

• Onset of the swelling: acute or chronic
• Characteristic: pitting and non-pitting edema
• Timing of the day when the swelling is worst.
• Location of swelling. Whether it is unilateral or bilateral.
• Tenderness in the swelling.
• Change in color or blisters at the site of the swelling.
• The exacerbation of edema with changes in the position of the patient.
• Dependent edema occurs in venous insufficiency. It improves with the elevation of legs. The edema with reduced plasma oncotic pressure as underlying etiology is not improved by elevating the legs.
• Medication history.
• Medical history. Any coexisting heart, renal, or liver disease.

What causes Anasarca

The common causes are:

• Exacerbation of congestive heart failure
• Exacerbation of chronic renal disease
• Hepatic cirrhosis
• Kwashiorkor disease
• Nephrotic syndrome
• Pregnancy
• Allergic reactions (anaphylaxis or urticaria)
• Adverse effects of medications (beta-blockers, calcium channel blockers, alpha-methyl dopa, corticosteroids, testosterone, estrogen, cyclophosphamide, cyclosporine)

Who is at the Highest Risk

• Poorly controlled underlying systematic diseases.
• Severe malnutrion
• Exposure to allergens

Diagnosis

The diagnostic study of choice depends upon the underlying etiology. The following tests should be carried out:

• Serum BNP, Chest X-ray and Cardiac Echocardiography: To assess heart failure in cardiac failure patients.
• Serum creatinine, blood urea nitrogen, complete metabolic profile and renal ultrasound: To assess renal functions in chronic kidney disease patients.
• Liver function tests and coagulation profile test: In patients with liver cirrhosis.
• Serum albumin level: In protein losing nephropathy, decrease protein intake, and deranged liver functions.
• Nocturnal sleep studies in obstructive sleep apnea patients.

Treatment Options

Medical therapies should be specifically directed towards underlying etiology.

• Diuretics, oxygen, inotropic drugs, and vasodilators in cardiac patients.
• Albumin administration is helpful in improving symptoms, survival and reducing ascities in cirrhotic patients.
• Hemodialysis, vitamin D, and erythropoietin for end-stage renal disease patients.
• Lactulose, diuretics, and antibiotics in hepatic cirrhosis patients.
• I/V adrenaline, intravenous fluids, and inhaled bronchodilators are administered in patients with allergic reactions.

Prevention

• Leg elevation and pneumatic compression stocking to promote venous and lymphatic drainage from lower limbs.
• Edema in lower limbs increases the risk for skin breakouts and, venous ulcers. Topical corticosteroid creams and emollients are applied to hydrate the skin and prevent cutaneous infection.