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Overview |
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Definition |
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Edema (also known as dropsy or fluid retention) is the accumulation of
excessive amounts of fluid in the interstitial space due to imbalance between
hydrostatic and oncotic pressure. It is a symptom caused by an underlying
disease or disorder. Edema may either be localized due to venous/lymphatic
obstruction or increased vascular permeability, or systemic due to organ
failure. It may be mild and cyclical, as in fluid retention associated with
menses, or severe and life-threatening, as in angioneurotic or cerebral edema.
Types of edema include the following.
- Angioneurotic edema (angioedema/Quincke's disease): recurrent
swelling of skin, mucous membranes, viscera, or brain with sudden onset lasting
from hours to days
- Blue edema: cyanosis of swollen extremity
- Brown edema: associated with chronic, passive congestion of the
lungs
- Cardiac edema: associated with congestive heart failure
- Cerebral edema: affecting the neuropile and white
matter—often associated with diabetic ketoacidosis
(DKA)
- Corneal edema: swelling of the cornea
- Cystoid macular: swelling in posterior pole of the eye
- High Altitude Pulmonary Edema (HAPE): potentially life-threatening
noncardiogenic altitude illness
- Idiopathic leg edema: swollen legs with no apparent cause
- Lipedema: fat/fluid accumulation in subcutaneous tissues
- Lymphedema: abnormal accumulation of lymph fluid
- Malignant edema: anthrax
- Menstrual edema: associated with hormonal cycle
- Nutritional edema: from excess fluid and salt intake and insufficient
protein intake
- Pulmonary edema: affecting the lungs and most commonly due to cardiac
disorders
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Etiology |
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Vary according to age, gender, underlying disorders.
Cyclical/generally non–life-threatening disorders,
often evident in lower extremities only, include the following
causes.
- Sitting or standing for extended periods: reduces blood flow so blood
"pools" in veins, inhibiting oncotic movement
- Heat: expands blood vessels, allowing greater hydrostatic
effusion
- Medications (steroids, NSAIDs, antidepressants, HRT): increased
hydrostatic movement
- Menstruation/pregnancy: hormonal changes affect hydrostatic/oncotic
pressure gradients
- Damage to lymphatic system
- Infection/injury: vein damage impairs fluid movement
- Obesity
- High salt intake
- Allergies (food, insect bites)
- Hypoalbuminemia
- Proteinuria
Chronic and/or potentially life-threatening underlying disorders, include the
following causes.
- Renal, cardiac, hepatic, thyroid diseases
- Hypothyroidism
- High/low blood pressure
- Pregnancy
- Vascular and arterial diseases
- Thrombosis
- Weakened venous system/varicose veins
- Infection/inflammation
- Tumors
- Short-term exposure to altitude combined with heavy physical
exertion
- DKA, head trauma, anoxia, exposure to toxic
substances
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Risk Factors |
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The underlying cause of life-threatening conditions must be identified. At
higher risk are those with the following.
- Radiation to surgical sites following lymphadenectomy increases
lymphedema risk
- Genetic lymphatic abnormalities
- Obesity
- High salt intake
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Signs and Symptoms |
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Will vary according to disorder.
- Swollen extremities (possibly accompanied by pain, redness, heat, and
open sores)
- Facial puffiness
- Abdominal bloating
- Shortness of breath, extreme difficulty breathing, coughing up blood
(pulmonary/HAPE)
- Sudden change in mental status/abnormal neurological signs,
respiratory arrest (cerebral edema associated with DKA)
- Muscular pain due to bloating and
swelling
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Differential
Diagnosis |
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- Inflammatory diseases (gout, rheumatoid arthritis)
- Preeclampsia (toxemia)
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Diagnosis |
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Physical Examination |
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Varies according to underlying disorder; may include the
following.
- Swelling in face, limbs, extremities, and/or trunk; weight
gain
- Dermatological lesions may be present
- Pulmonary edema: fluid accumulation in pleural cavity
- Cerebral edema: intracellular
(cytotoxic)—cellular swelling in gray matter;
extracellular (vasogenic)—white matter moist and
swollen; microscopically—microvacuolization/halos
surrounding nuclei
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Laboratory Tests |
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Reduced serum albumin; increased fecal loss of
antiprotease |
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Pathology/Pathophysiology |
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Excess fluid in intercellular tissue spaces due to the
following.
- Increased hydrostatic pressure gradient, or elevated extracellular
fluid volume
- Decrease in overall osmotic pressure gradient, or increase in
capillary permeability to plasma
protein
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Imaging |
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- CT, MRI, X ray as appropriate to aid in
diagnosis
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Other Diagnostic
Procedures |
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Because certain forms of edema are life-threatening, treating immediate
symptoms may be necessary before diagnosis of underlying disorder is
established.
Medical history/interview to determine:
- Time frame/longevity of symptoms
- Whether continuous, intermittent, or cyclical (e.g., with
menses)
- Diet
- History of cardiac/renal/hepatic/thyroid disease
- Exposure to toxic fumes
- Allergic reactions
Physical examination:
- Location
- Degree of pitting (indentation remaining following application of
pressure with finger)
- Cutaneous wounds/sores
- Varicose veins
- Blood clots
- Shortness of breath
- Determine underlying cause (e.g., pregnancy; cardiac, renal, hepatic,
thyroid disease)
Special tests:
- Serum electrolyte/albumin tests
- Urinalysis
- ECG
- Echocardiography
- Liver function
test
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Treatment Options |
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Treatment Strategy |
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Treatment will depend upon underlying disorder. In pulmonary edema or HAPE,
immediate hospitalization and/or treatment with oxygen, diuretics, and/or other
medications are necessary.
To reduce swelling:
- Salt reduction diet
- Daily exercise
- Periodic elevation of legs above heart level
- Diuretics
- Support hose
- Massage
- Complete Decongestive Therapy (CDT): compression physical therapy
(including sleeves, pumps) to move fluid through alternate lymph channels for
reabsorption by the body, compression bandaging, skin
care/manipulation.
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Drug Therapies |
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Diuretics effectively reduce fluid levels; however, they also deplete
potassium, magnesium, B vitamins, and calcium, which results in loss of bone
mass.
- Loop/thiazide diuretics (heart failure, cirrhosis, nephrosis, renal
failure, hypertension)
- Potassium-sparing diuretics (hypokalemia caused by other diuretics,
hypertension)
- Carbonic anhydrase inhibitors (glaucoma, HAPE, heart
failure)
- Osmotic diuretic (Mannitol—1 gm/kg at onset
of neurologic symptoms in DKA-related edema)
- Morphine (in pulmonary disease reduces congestion/anxiety)
- Corticosteroid/immunosuppressives
- Medications appropriate for underlying
disorder
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Surgical Procedures |
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- Surgical removal of fat and fluid deposits in lipedema
- Attempt to reestablish lymph/blood
flow
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Complementary and Alternative
Therapies |
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While following nutritional and herbal support guidelines may help alleviate
edema, it is essential that the underlying cause be addressed. Edema is
multi-factorial. Choose the appropriate guidelines according to the underlying
cause. |
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Nutrition |
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- Eliminating food allergens from the diet decreases inflammation edema
secondary to inflammatory processes.
- A low-salt, high-protein diet may help resolve edema. High protein is
contraindicated in renal involvement. Dietary intake of sugar and refined
carbohydrates should also be reduced.
- Increase dietary potassium with diuretic use (e.g., bananas,
apricots, and green leafy vegetables).
- Some foods are natural diuretics: asparagus, parsley, beets, grapes,
green beans, leafy greens, pineapple, pumpkin, onion, leeks, and garlic. These
foods also support kidney and liver function.
- Vitamin B6 (50 to 100 mg/day) induces diuresis. Thiamine may be
depleted with Lasix and should be supplemented (200 mg/day).
- Vitamins C (1,000 to 1,500 mg tid), E (400 to 800 IU/day), and
coenzyme Q10 (50 to 100 mg bid) protect and strengthen blood vessels.
- Potassium aspartate (20 mg/day) may need to be supplemented if using
diuretics.
- Magnesium (200 mg bid to tid) and calcium (1,000 mg/day) influence
intra- and intercellular fluid exchange and may be depleted with diuretic
use.
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Herbs |
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Herbs are generally a safe way to strengthen and tone the body's systems. As
with any therapy, it is important to ascertain a diagnosis before pursuing
treatment. Herbs may be used as dried extracts (capsules, powders, teas),
glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless
otherwise indicated, teas should be made with 1 tsp. herb per cup of hot water.
Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for
roots. Drink 2 to 4 cups/day. Tinctures may be used singly or in combination as
noted.
A general diuretic should contain herbs that support circulation and
lymphatic drainage. They are best administered in a cooled tea (four to six
cups/day), although a tincture may also be used (30 to 60 drops qid). Drinking
the tea cool will support circulation and lymphatic drainage without increasing
vasodilation. Combine three of these herbs with equal parts of two to three
additional herbs from the following categories, as indicated: cleavers
(Galium aparine), yarrow (Achillea millefolium), oatstraw (Avena
sativa), elder (Sambucus nigra), red clover (Trifolium pratense),
and red root (Ceonothus americanus).
Cyclic edema and idiopathic orthostatic edema:
- Ginkgo (Ginkgo biloba) strengthens the integrity of the
vasculature and its use has improved cyclical edema associated with hormonal
changes.
- Bilberry (Vaccinium myrtillus) is a gentle diuretic as well as
a tonic for the vasculature.
- Topical applications of creams containing one or more of the
following may be helpful in increasing vascular integrity in orthostatic edema:
horse chestnut (Aesculus hippocastanum), butcher's broom (Ruscus
asuleatus), sweet clover (Melilotus officinalis), and rue (Ruta
graveolens).
Renal insufficiency:
Use caution in administering diuretics with renal failure. Herbal options
include parsley (Petroselinum crispum), dandelion leaves (Taraxacum
officinale), buchu (Barosma betulina), couch grass (Agropyron
repens), horsetail (Equisetum arvense), and goldenrod (Solidago
virgaurea)
Cardiac and/or pulmonary involvement:
- Hawthorn (Crataegus monogyna), motherwort (Leonurus
cardiaca), rosemary (Rosmarinus officinalis), and linden (Tilia
cordata)
- Lily of the valley (Convalleria majalus), night-blooming
cereus (Selenicereus grandiflorus), and broom (Sarothamnus scoparius)
have toxic side effects but may be added to the cardiopulmonary formula
under physician supervision.
Hepatic involvement (may be used in conjunction with treatment for cyclic
edema) may respond to milk thistle (Silybum marianum), dandelion root
(Taraxacum officinale), turmeric (Curcuma longa), and artichoke
leaves (Cynara scolymus). |
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Homeopathy |
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Because of the many presentations of edema, remedies are best chosen by an
experienced homeopath. |
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Physical Medicine |
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- Dry skin brushing. Before bathing, briskly brush the entire skin
surface with a rough washcloth, loofa, or soft brush. Begin at the feet and work
up. Always stroke in the direction of the heart. This helps facilitate lymphatic
circulation. There is no need to press deeply as the lymph are superficial
vessels.
- Cold compresses to the face or backs of the legs with yarrow tea may
give temporary relief of edema.
- Contrast hydrotherapy involves alternating hot and cold application
to bring nutrients to the site and to diffuse metabolic waste from inflammation.
The overall effect is decreased inflammation, pain relief, and enhanced healing.
Using this technique with hand and/or foot baths may help to improve circulation
and lymphatic drainage. Alternate three minutes hot with one minute cold. Repeat
three times to complete one set. Do two to three sets/day. Use caution in areas
of decreased sensation by ensuring that the hot application does not
burn.
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Acupuncture |
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Acupuncture may improve fluid balance and provide support in the treatment of
underlying cause and improve circulation. |
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Massage |
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Therapeutic massage can assist with lymph drainage and improve
circulation. |
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Patient Monitoring |
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Monitor for:
- Fluid input/outflow
- Potassium levels, electrolyte balance, blood pressure, allergic
reactions, GI bleeding, CNS effects, muscle cramps, and other side effects of
diuretic use
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Other
Considerations |
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Daily exercise is highly beneficial in general, unless contraindicated by
underlying condition. |
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Prevention |
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- Pulmonary edema: reduce risk by treating cardiac disorder
- Lymphedema: keep skin clean/supple, protect surgical site from
injury; drainage-promoting exercises, elevation of affected limb
- Idiopathic disease: reduce salt intake; avoid constrictive clothing
around legs and wrists
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Complications/Sequelae |
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- Hypertensive disease
- Pulmonary edema/HAPE/cerebral edema are life-threatening
- Infection/ulceration of cutaneous
lesions
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Prognosis |
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- Life-threatening edema treatable and often curable with prompt
attention combined with treatment for underlying disorder
- Effective reduction of swelling attainable with diuretics and
compression therapies
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Pregnancy |
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Orthostatic edema is common in pregnancy and can be safely addressed with leg
elevation, hawthorn tea, and topical applications. Edema may also be a sign of
preeclampsia and should be monitored closely. |
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References |
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Balch JF, Balch PA. Prescription for Nutritional Healing. Garden City
Park, NY: Avery Publishing Group; 1997.
Bartram T. Encyclopedia of Herbal Medicine. Dorset, England: Grace
Publishers; 1995:73, 155, 156, 188.
Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic
Guide to Herbal Medicines. Boston, Mass: Integrative Medicine
Communications; 1998:424, 425, 429.
Mayo Foundation for Medical Education and Research. Available at
www.healthanswers.com
MDX Health Digest. Available at www.thriveonline.com
Mindell E, Hopkins V. Prescription Alternatives. New Canaan, Conn:
Keats Publishing Inc; 1998.
Vanderbilt University Medical Center. Available at www.mc.vanderbilt.edu
Weiss RF. Herbal Medicines. Beaconsfield, England: Beaconsfield
Publishers, Ltd; 1988:188-191,
241. |
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Copyright © 2000 Integrative Medicine
Communications This publication contains
information relating to general principles
of medical care that should not in any event be construed as specific
instructions for individual patients. The publisher does not accept any
responsibility for the accuracy of the information or the consequences arising
from the application, use, or misuse of any of the information contained herein,
including any injury and/or damage to any person or property as a matter of
product liability, negligence, or otherwise. No warranty, expressed or implied,
is made in regard to the contents of this material. No claims or endorsements
are made for any drugs or compounds currently marketed or in investigative use.
The reader is advised to check product information (including package inserts)
for changes and new information regarding dosage, precautions, warnings,
interactions, and contraindications before administering any drug, herb, or
supplement discussed herein. | |