Definition:
Excessive build-up of fluid in the tissues, or an increase in tissue mass. Swelling can occur throughout the body (generalized swelling) or swelling can be limited to a specific part of the body.
Alternative names:
Pitting edema; Dependent edema; Generalized swelling; Edema; Anasarca
Considerations:
This document primarily discusses overall swelling. See the specific documents listed in the definition for information that is specific to swelling in a specific location.
Slight edema of the legs commonly occurs in warm summer months.
Generalized swelling or massive edema (also called anasarca) is a common sign in severely ill people. While slight edema may be difficult to detect, especially in an overweight person, massive edema is very obvious.
Very often, widespread edema is both long-term and progressive and the causes vary significantly.
Edema may be pitting (when pressing a finger against a swollen area for 10 seconds and then quickly removing it, an indentation is left that fills slowly) or nonpitting (when pressing a finger against a swollen area for 10 seconds and then quickly removing it, no indentation is left in the skin).
Common causes:
? too much salt or sodium
? burns
? sunburn
? too little albumin in the blood (hypoalbuminemia)
? malnutrition
? pregnancy
? drugs
o androgenic and anabolic steroids
o antihypertensives
o corticosteroids such as prednisone (causes sodium retention)
o estrogens
o anti-inflammatory drugs (see NSAIDs)
? intravenous saline administration or tube feedings
? nephrotic syndrome
? acute glomerulonephritis
? heart or liver failure
Home care:
Follow prescribed therapy to treat the underlying cause of the edema. Discuss with your health care provider the options to prevent skin breakdown (for chronic edema) such as a pressure mattress, lamb’s wool pad, or flotation ring.
Maintain everyday activities. When lying down, keep limbs above the heart level, if possible, to facilitate drainage. Do not do this if shortness of breath results.
Massage swollen areas regularly, particularly if edema has formed around the hip, buttocks, or back.
Reduced sodium (salt) in the diet may be recommended.
Call your health care provider if :
? there is any unexplained swelling.
What to expect at your health care provider’s office
Except in emergency situations (such as cardiac failure or pulmonary congestion), the medical history will be obtained and a physical examination performed.
Medical history questions documenting swelling in detail may include:
? time pattern
o When did you first notice this?
o Is it present all the time?
o Does it come and go?
? quality
o How much swelling is there?
o When you poke the area with a finger, does the dent remain?
? location
o Is it overall or in a specific area (localized)?
o If swelling is in a specific area, what is that area?
? other
o What seems to make the swelling better?
o What seems to make the swelling worse?
o What other symptoms are also present?
Diagnostic tests that may be performed include:
? albumin levels measured
? ECG
? echocardiography
? serum electrolyte tests
? urinalysis
? X-rays
? liver and kidney function tests
Intervention:
Treatment may include fluid and sodium restriction, diuretics, digoxin, and (rarely) intravenous albumin administration. In some cases corticosteroids such as prednisone or immunosuppressive medications may be given. Fluid intake and output should be monitored and the patient should be weighed daily.
Avoid alcohol if liver disease (such as cirrhosis and hepatitis) is the problem. Vascular support hose (TED hose) may be advised.
After seeing your health care provider:
You may want to add a diagnosis related to swelling to your personal medical record.
