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Edema

Edema is soft tissue swelling due to abnormal expansion of interstitial fluid volume. LOCALIZED EDEMA Limited to a particular organ or vascular bed; easily distinguished from generalized edema. In cirrhosis, arteriovenous shunts lower effective renal perfusion. Ascites accumulates when increased intrahepatic vascular resistance produces portal hypertension.

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Yeni Anggraini
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47 views

Edema

Edema is soft tissue swelling due to abnormal expansion of interstitial fluid volume. LOCALIZED EDEMA Limited to a particular organ or vascular bed; easily distinguished from generalized edema. In cirrhosis, arteriovenous shunts lower effective renal perfusion. Ascites accumulates when increased intrahepatic vascular resistance produces portal hypertension.

Uploaded by

Yeni Anggraini
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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DEFINITION

Edema is soft tissue swelling due to abnormal

expansion of interstitial fluid volume Edema fluid can be a plasma transudate that accumulates when movement fluid from vascular to interstitial space.

LOCALIZED EDEMA
Limited to a particular organ or vascular bed ; easily

distinguished from generalized edema. Unilateral extremity edema is usually due to venous or limphatic obstruction (e.g., deep venous thrombosis, tumor obstruction, primary lymphedema). Stasis edema of a paralyzed lower extremity may also occur. Allergic reactions (angioedema) and superior vena caval obstruction are causes of localized facial edema. Bilateral lower extremity edema may have localized causes : e.g., inferior vena caval obstruction, compressioon due to ascites/abdominal mass. Ascites (fluid in peritoneal cavity) and hydrothorax (in pleural space) may also present as isolated localized edema, due to inflammation or neoplasm.

GENERALIZED EDEMA
Soft tissue swelling of most or all regions of the body. Bilateral lower extremity swelling, more pronounced

after standing for several hours Pulmonary edema are usually cardiac in origin. Periorbital edema noted on awekening often result from renal disease and impaired Na excretion. Ascites and edema of lower extremities and scrotum are frequent in cirrhosis or CHF. In CHF, diminished cardiac output and effective arterial blood volume result in both decreased renal perfusion and increased venous pressure with resultant renal Na retention due to renal vasoconstriction, intrarenal blood flow redistribution and secondary hyperaldosteronism.

GENERALIZED EDEMA
In cirroshis, arteriovenous shunts lower effective

renal perfusion, resulting in Na retention. Ascites accumulates when increased intrahepatic vascular resistance produces portal hypertension. Reduced serum albumin and increased abdominal pressure, promote lower extremity edema. In nephrotic syndrome, massive renal loss of albumin: lowers plasma oncotic pressure promoting fluid transudation into interstitium lowering of effective blood volume stimulates

GENERALIZED EDEMA
In acute or chronic renal failure, edema occurs if Na

intake exceeds kidneys abilty to excrete Na secondary to marked reductions in glomerular filtration. Severe hypoalbuminemia [<25 g/L (2.5 g/dL)] of any cause (e.g., nephrosis nutritional deficiency states, chronic liver disease) may lower plasma oncotic pressure sufficiently to cause edema. Less common causes generalized edema : idiophatic edema, a syndrome of recurrent rapid weight gain and edema in women of reproductive age, hypothyroidism, in which myxedema is typically located in the pretibial region, drugs (such as steroids, estrogens, vasodilators, pregnancy,

Edema ? Localized no ? Albumin < 2.5g/dL no ? JVD or CO no


? Azotemia or active urine sediment

DIAGNOSTIC APPROACH TO EDEMA

yes

Venous or lymphatic obstruction Local injury (thermal, immune, infectious, mechanical) Severe malnutrition Cirrhosis Nephrotic syndrome

yes

yes

Heart failure

yes Renal failure

no Consider : - Drug induced (steroids, estrogens, vasodilators) - Hypothyroidism

DIURETICS FOR EDEMA


Drug Distal, K-lossing Hydrochlorothiazide 25, 50 mg 25-200 mg First choise; causes hypokalemia; need GFR > 25 mL/min Strength Common Dose Comments

Chlorthalidone (hygroton)

25, 50, 100 mg

100 mg qd or qod

Long-acting (up to 72 h); hypokalemia; need GFR > 25 mL/min

Metalazone (Zaroxylin)

1 mg

1-10 mg qd

Long-acting; hypokalemia; effective with low GFR

DIURETICS FOR EDEMA


Drug Loop Furosemide (lasix) 20, 40, 80 mg 40-120 mg qd or bid Short-acting; potent; effective with low GFR Strength Common Dose Comments

Bumetanide

0.5, 1 mg

0.5-2 mg qd or bid

May be used if allergic to furosemide


Longer-acting; side effects at high doses

Ethacrynic acid (Edecrin)

25, 50 mg

50-200 mg qid

DIURETICS FOR EDEMA


Drug Distal, K-sparing Spironolactone (aldactone) 25 , 100 mg 25-100 mg qid Hyperkalemia; acidosis; block aldosterone; gynecomastia, impertence, amenorrhea; onset takes 2-3 days; not if GFR < 25 mL/min Hyperkalemia; once daily; less potent than spironolactone Hyperkalemia; less potent than spironolactone; renal stones Strength Common Dose Comments

Amiloride (Midamor)

5 mg

5-10 mg qd or bid

Triamterene (Dyazide)

50, 100 mg

100 mg bid

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