Anasarca patient information

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

## Contents

* 1 Overview
* 2 What are the symptoms of Anasarca
* 3 What causes Anasarca
* 4 Who is at the Highest Risk
* 5 When to Seek Urgent Medical Care
* 6 Diagnosis
* 7 Treatment Options
* 8 Prevention
* 9 Sources

## Overview

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

## What are the symptoms of Anasarca

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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

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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

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

## When to Seek Urgent Medical Care

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* 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

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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

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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

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* 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

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1. ↑ 1.0 1.1 Yale SH, Mazza JJ (2001). "Approach to diagnosing lower extremity edema". Compr Ther. 27 (3): 242–52. doi:10.1007/s12019-001-0021-5. PMID 11569326.
2. ↑ Ely JW, Osheroff JA, Chambliss ML, Ebell MH (2006). "Approach to leg edema of unclear etiology". J Am Board Fam Med. 19 (2): 148–60. doi:10.3122/jabfm.19.2.148. PMID 16513903.CS1 maint: Multiple names: authors list (link)
3. ↑ Topham EJ, Mortimer PS (2002). "Chronic lower limb oedema". Clin Med (Lond). 2 (1): 28–31. doi:10.7861/clinmedicine.2-1-28. PMC 4953165. PMID 11871635.
4. ↑ 4.0 4.1 Trayes KP, Studdiford JS, Pickle S, Tully AS (2013). "Edema: diagnosis and management". Am Fam Physician. 88 (2): 102–10. PMID 23939641.CS1 maint: Multiple names: authors list (link)
5. ↑ O'Brien JG, Chennubhotla SA, Chennubhotla RV (2005). "Treatment of edema". Am Fam Physician. 71 (11): 2111–7. PMID 15952439.CS1 maint: Multiple names: authors list (link)
6. ↑ Cho S, Atwood JE (2002). "Peripheral edema". Am J Med. 113 (7): 580–6. doi:10.1016/s0002-9343(02)01322-0. PMID 12459405.
7. ↑ Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG; et al. (2009). "2009 focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation". Circulation. 119 (14): e391–479. doi:10.1161/CIRCULATIONAHA.109.192065. PMID 19324966.CS1 maint: Multiple names: authors list (link)
8. ↑ Walayat S, Martin D, Patel J, Ahmed U, N Asghar M, Pai AU; et al. (2017). "Role of albumin in cirrhosis: from a hospitalist's perspective". J Community Hosp Intern Med Perspect. 7 (1): 8–14. doi:10.1080/20009666.2017.1302704. PMC 5463675. PMID 28634518.CS1 maint: Multiple names: authors list (link)
9. ↑ Alguire PC, Mathes BM (1997). "Chronic venous insufficiency and venous ulceration". J Gen Intern Med. 12 (6): 374–83. doi:10.1046/j.1525-1497.1997.00063.x. PMC 1497122. PMID 9192256.
10. ↑ Berliner E, Ozbilgin B, Zarin DA (2003). "A systematic review of pneumatic compression for treatment of chronic venous insufficiency and venous ulcers". J Vasc Surg. 37 (3): 539–44. doi:10.1067/mva.2003.103. PMID 12618689.CS1 maint: Multiple names: authors list (link)