Anasarca patient information

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

Overview[edit | edit source]

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

What are the symptoms of Anasarca[edit | edit source]

The following questions should be asked to the patient regarding edema.^[1][2][3]

• 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[edit | edit source]

The common causes are: ^[4][5][6][1]

• 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[edit | edit source]

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

When to Seek Urgent Medical Care[edit | edit source]

• The pulmonary edema is a life-threatening medical condition and its emergence requires urgent medical care. The clinical symptoms of pulmonary edema are tachypnea, dyspnea, cough with straw-colored sputum. On chest auscultation crackles and decreased breath sounds are heard. It is managed aggressively by intravenous diuretics, vasodilators, and oxygen therapy.^[7]

Diagnosis[edit | edit source]

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[edit | edit source]

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.^[8]
• 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[edit | edit source]

• Leg elevation and pneumatic compression stocking to promote venous and lymphatic drainage from lower limbs.^[9][10]
• 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.^[4]

Sources[edit | edit source]