From the Guidelines
Edema should be managed based on its underlying cause, with treatment options including lifestyle modifications, medications, and in some cases, specialized therapies like massage and compression garments, as the most recent and highest quality study 1 suggests that understanding the cause of edema is crucial for effective management.
Causes of Edema
- Increased hydrostatic pressure, as seen in heart failure
- Decreased oncotic pressure, which can occur in liver disease or malnutrition
- Lymphatic obstruction, leading to conditions like lymphedema ### Treatment Approaches
- For mild edema, elevating the affected limb, reducing salt intake to less than 2,000 mg daily, and wearing compression stockings can help
- Diuretics like furosemide (20-80 mg daily) or hydrochlorothiazide (12.5-50 mg daily) may be prescribed for removing excess fluid
- For edema caused by heart failure, ACE inhibitors such as lisinopril (5-40 mg daily) or ARBs like losartan (25-100 mg daily) are often used, but with caution due to the potential risk of angioedema, as highlighted in the study 1
- Protein deficiency edema requires dietary protein supplementation
- Lymphedema benefits from specialized massage therapy and custom compression garments ### Important Considerations
- Prompt medical attention is necessary for sudden or severe edema, especially when accompanied by shortness of breath, chest pain, or one-sided swelling, as these may indicate serious conditions like heart failure, kidney disease, or blood clots
- The study 2 from 2003 discusses the association between thiazolidinediones and fluid retention, emphasizing the need for careful patient selection and monitoring when using these medications
- More recent guidance 1 from 2013 focuses on hereditary angioedema, acquired C1 inhibitor deficiency, and angiotensin-converting enzyme inhibitor-associated angioedema, providing updated recommendations for diagnosis and management ### Diagnosis and Management of Specific Types of Edema
- Hereditary angioedema (HAE) and acquired C1 inhibitor deficiency require specific diagnostic tests and treatments, as outlined in the study 1
- ACE inhibitor-associated angioedema is a significant concern, with recommendations for discontinuation of the offending agent and consideration of alternative treatments, as discussed in 1
From the Research
Definition and Causes of Edema
- Edema is defined as an accumulation of fluid in the interstitial compartment, resulting from imbalanced capillary hemodynamics 3.
- It can be caused by numerous pathologies, including medications, systemic diseases, and venous insufficiency 3, 4.
- The chronicity and laterality of edema guide its evaluation, with acute unilateral lower-extremity edema warranting immediate evaluation for deep venous thrombosis 3.
Evaluation and Diagnosis of Edema
- Evaluation of edema should begin with obtaining a basic metabolic panel, liver function tests, thyroid function testing, brain natriuretic peptide levels, and a urine protein/creatinine ratio 3.
- Validated decision rules, such as the Wells and STOP-Bang criteria, can guide decision-making regarding the possibility of venous thromboembolic disease and obstructive sleep apnea, respectively 3.
- Duplex ultrasonography with reflux can help diagnose chronic venous insufficiency, while lymphoscintigraphy can be performed if the diagnosis of lymphedema is unclear 3, 5.
Treatment and Management of Edema
- Treatment of edema is specific to its etiology, with diuretics effective but only for systemic causes of edema 3.
- Ruscus extract and horse chestnut seed demonstrate moderate-quality evidence to improve edema from chronic venous insufficiency, while compression therapy is effective for most causes of edema 3.
- Skin care is crucial in preventing skin breakdown and venous ulcers, with emollients and topical steroid creams used to manage eczematous (stasis) dermatitis 5.
- Patients with lymphedema may benefit from the use of pneumatic compression devices or compression stockings, as well as referral to a lymphoedema specialist for patient education and management 5, 6.