From the Guidelines
Fluid overload (hypervolemia) symptoms include dyspnea, orthopnea, peripheral edema, jugular venous distention, pulmonary crackles, and weight gain, and should be treated promptly with loop diuretics to reduce morbidity and mortality, as recommended by the 2013 ACCF/AHA guideline for the management of heart failure 1.
Symptoms of Fluid Overload
The symptoms of fluid overload (hypervolemia) are primarily related to the excess fluid in the body and can be categorized into:
- Respiratory symptoms: dyspnea, orthopnea
- Cardiovascular symptoms: jugular venous distention, pulmonary crackles
- Peripheral symptoms: peripheral edema
- General symptoms: weight gain These symptoms can be assessed through a thorough history and physical examination, as well as key tests such as chest radiographs, electrocardiogram, and echocardiography 1.
Treatment of Fluid Overload
The treatment of fluid overload involves the use of loop diuretics, such as furosemide (Lasix) 40mg IV initially, which can be increased to 80-120mg if needed, as recommended by the 2013 ACCF/AHA guideline for the management of heart failure 1.
- For patients with acute heart failure, start with furosemide 40mg IV bolus, followed by continuous infusion at 5-10mg/hour if necessary.
- Alternatively, bumetanide 1-2mg IV or torsemide 10-20mg IV can be used.
- Fluid restriction to 1.5-2 liters per day and sodium restriction to less than 2g daily are important adjunctive measures.
- Monitor daily weights, intake/output, electrolytes (particularly potassium and sodium), and renal function. In severe cases, oxygen therapy may be needed to maintain oxygen saturation above 92% 1.
Management of Diuretic Resistance
For patients with diuretic resistance, adding a thiazide diuretic like metolazone 2.5-5mg orally or spironolactone 25mg daily may enhance diuresis through sequential nephron blockade, as recommended by the 2013 ACCF/AHA guideline for the management of heart failure 1. Ultrafiltration may be considered in refractory cases. It is essential to note that the diagnosis of heart failure is primarily based on signs and symptoms derived from a thorough history and physical examination, and that the use of loop diuretics should be guided by the patient's volume status and clinical symptoms 1.
From the Research
Symptoms of Fluid Overload (Hypervolemia)
The symptoms of fluid overload (hypervolemia) are not explicitly stated in the provided studies. However, the studies discuss the consequences of fluid overload on various organ systems and the importance of managing fluid overload in clinical scenarios such as heart failure and critical illness 2.
Clinical Scenarios Associated with Fluid Overload
Fluid overload is associated with various clinical scenarios, including:
- Heart failure 2, 3, 4
- Critical illness 2
- End-stage renal failure (ESRF) 5
- Chronic kidney disease (CKD) 4, 6
- Nephrotic syndrome 4
- End-stage liver disease 4
Management of Fluid Overload
The management of fluid overload typically involves the use of diuretics, which are the cornerstone of therapy for volume overload 4. The studies discuss the use of different classes of diuretics, including loop diuretics and thiazide diuretics, and their effectiveness in managing fluid overload in various clinical scenarios 3, 5, 4, 6.