Edema

Edema refers to palpable swelling from accumulation of fluid in the interstitial tissue.

Differential Diagnosis

Generalized Edema

• Congestive heart failure
• Nephrotic syndrome
• Cirrhosis
• Renal failure
• Medication-related (CCBs, NSAIDs, corticosteroids, pregabalin)
• Hypothyroidism (myxedema)
• Preeclampsia

Unilateral Edema

• Deep venous thrombosis
• Cellulitis
• Compartment syndrome
• Lymphedema
• Venous insufficiency
• Baker cyst rupture

Facial/Periorbital

• Angioedema
• Anaphylaxis
• Nephrotic syndrome
• Superior vena cava syndrome
• Allergic reaction

Evaluation

• Assess distribution (unilateral vs bilateral, dependent vs diffuse)
• Pitting vs non-pitting
• Labs: BMP, albumin, BNP, urinalysis, LFTs based on clinical suspicion
• Unilateral leg edema: obtain DVT ultrasound if clinically suspicious
• CXR if pulmonary edema suspected

Management

• Treat underlying cause
• Diuretics for volume overload (Furosemide 20-40mg IV)
• Elevation and compression for venous insufficiency
• Anticoagulation for DVT
• Epinephrine for angioedema with airway compromise

Disposition

• Admit for new heart failure, renal failure, or anasarca
• Admit for unilateral edema with confirmed DVT requiring monitoring
• Discharge with follow-up for stable chronic edema with known cause

See Also

• Deep venous thrombosis
• Congestive heart failure
• Angioedema
• Unilateral leg swelling