From the Research
The workup of pitting edema should begin with a thorough history and physical examination to determine the underlying cause, including assessment of the distribution of edema, timing of onset, and associated symptoms, as recommended by the most recent study 1. The initial evaluation should include vital signs, such as blood pressure, to evaluate for hypertension.
- Initial laboratory tests should include:
- Complete blood count
- Comprehensive metabolic panel (including liver and kidney function tests)
- Urinalysis
- Thyroid function tests
- Measure serum albumin to assess for hypoproteinemia
- An electrocardiogram and echocardiogram are important to evaluate cardiac function, particularly left ventricular ejection fraction and valvular abnormalities, as suggested by 1.
- A chest X-ray can help identify pulmonary congestion or pleural effusions.
- If deep vein thrombosis is suspected, a venous duplex ultrasound of the affected limb is warranted, as recommended by 1.
- For patients with suspected liver disease, additional tests like liver ultrasound and hepatitis serologies may be necessary.
- In cases of suspected nephrotic syndrome, 24-hour urine protein collection should be ordered. Treatment depends on the underlying cause, and the most effective treatment approach is often guided by the results of the initial workup, with a focus on addressing the underlying cause of the edema, as emphasized by 1. Pitting edema occurs when excess interstitial fluid accumulates due to increased hydrostatic pressure (as in heart failure), decreased oncotic pressure (as in liver disease or nephrotic syndrome), or increased capillary permeability (as in inflammation), as discussed in 1.