Conditions

Edema

Overview:
Edema (also known as dropsy or fluid retention) is the accumulation of fluid in spaces between the cells in the soft tissue of the body. Any part of the body may develop edema. The swelling can be localized in the face, arms, and neck, or may involve the legs and ankles.

The underlying causes of edema may be serious. Edema can indicate a much more profound illness, such as AIDS, cirrhosis of the liver, congestive heart failure, diabetes, or vena cava syndrome. More simply, edema can occur as a result of infection, prolonged bed rest, or allergies.

Signs and Symptoms:

• Swelling that involves the legs and ankles is known as dependent edema.
• Swelling around the eyes is known as periorbital edema.
• Corneal stroma is edema of the cornea
• Anasarca is generalized edema.
• Preeclampsia is a condition that occurs in approximately 5% of pregnant women, causing high blood pressure, fluid accumulation, and albuminuria (protein in the urine).

Other forms of edema:

• Angioneurotic edema (angioedema/Quincke's disease): recurrent swelling of skin, mucous membranes, viscera, or brain; with sudden onset lasting from hours to days
• Blue edema: cyanosis of swollen extremity
• Brown edema: associated with chronic, passive congestion of the lungs
• Cardiac edema: associated with congestive heart failure
• Cerebral edema: affecting the neuropile and white matter - often associated with diabetic ketoacidosis (DKA)
• Corneal edema: swelling of the cornea
• Cystoid macular: swelling in posterior pole of the eye
• High Altitude Pulmonary Edema (HAPE): potentially life-threatening noncardiogenic altitude illness
• Idiopathic leg edema: swollen legs with no apparent cause
• Lipedema: fat/fluid accumulation in subcutaneous tissues
• Lymphedema: abnormal accumulation of lymph fluid
• Malignant edema: anthrax
• Menstrual edema: associated with hormonal cycle
• Nutritional edema: from excess fluid and salt intake and insufficient protein intake
• Pulmonary edema: affecting the lungs and most commonly due to cardiac disorders

Diagnosis:

Because certain forms of edema are life threatening, treating immediate symptoms may be necessary before diagnosis of underlying disorder is established. In general, diagnosis is performed using the following procedures:

Medical history interview to determine:

• Time frame/longevity of symptoms
• Whether continuous, intermittent, or cyclical (e.g., with menses)
• Diet
• History of cardiac/renal/hepatic/thyroid disease
• Exposure to toxic fumes
• Allergic reactions

Physical examination:

• Location
• Degree of pitting (indentation remaining following application of pressure with finger)
• Cutaneous wounds/sores
• Varicose veins
• Blood clots
• Shortness of breath
• Determine underlying cause (e.g., pregnancy; cardiac, renal, hepatic, thyroid
  disease)

Special tests:

• Serum electrolyte/albumin tests
• Urinalysis
• ECG
• Echocardiography
• Liver function test

Treatment Options:

Treatment will depend upon underlying disorder. Some forms of edema will need immediate hospitalization, where other forms of edema may be treated to simply reduce the swelling.

Traditional Treatments:

The following treatments may be tried to reduce swelling:

• Salt reduction diet
• Daily exercise
• Periodic elevation of legs above heart level
• Diuretics
• Support hose
• Massage
• Complete Decongestive Therapy (CDT): compression physical therapy (including sleeves, pumps) to move fluid through alternate lymph channels for reabsorption by the body, compression bandaging, skin care/manipulation.

The following drug treatments may be prescribed:

• Loop/thiazide diuretics may be prescribed in cases of heart failure, cirrhosis, nephrosis, renal failure, or hypertension.
• Potassium-sparing diuretics can be prescribed in cases of hypokalemia caused by other diuretics or hypertension.
• Carbonic anhydrase inhibitors for glaucoma, HAPE, and heart failure.
• Osmotic diuretic (Mannitol-1 gm/kg at onset of neurologic symptoms in DKA-related edema)
• Morphine may be used in pulmonary disease to reduce congestion/anxiety.
• Corticosteroid/immunosuppressives
• Medications appropriate for underlying disorder

It's possible that the following surgical procedures may be necessary (although they are rare):

• Surgical removal of fat and fluid deposits in lipedema
• Attempt to reestablish lymph/blood flow

Complementary and Alternative Therapies:

Following nutritional and herbal support guidelines may help alleviate edema.

Nutritional Supplementation:

• Free-form amino acid complex can help alleviate protein deficiencies that are often linked to edema. Follow the label directions.
• Vitamin B complex can help reduce water retention. 50-100 mg of each major B vitamin twice daily, with meals.
• 1,500 mg of calcium and 1,000 mg of magnesium, daily ­ to replace minerals lost with correction of edema.
• Silica is a natural diuretic. Follow the label directions.
• Potassium is very important if taking diuretics. It helps to keep fluids on the inside of the cells. Take 99 mg daily.
• Vitamins C (1,000 to 1,500 mg three times a day), E (400 to 800 IU/day), and Coenzyme Q10 (50 to 100 mg twice a day) will protect and strengthen blood vessels.

Alternative Therapies:

• Alfalfa is a good source of important minerals. It also contains chlorophyll, a potent detoxifier. Take 2,000 to 3,000 mg daily, in divided doses.
• Hawthorn berries, horsetail, juniper, and uva ursi are diuretics. By increasing the output of urine, they help to counteract adema.
• Horse chestnut has been shown to reduce post-surgical adema.
• SP-6 Cornsilk Blend from Solaray contains corn silk and other herbs that aid the body in expelling excess fluids. Take 2 capsules three times daily.
• Other herbs that can be beneficial if you are suffering from edema include butcher's broom, dandelion root, lobelia, marshmallow, parsley, and pau d'arco tea.
  Warning: Do not take lobelia internally on an ongoing basis.
• Dry skin brushing. Before bathing, briskly brush the entire skin surface with a rough washcloth, loofa, or soft brush. Begin at the feet and work up. Always stroke in the direction of the heart. This helps facilitate lymphatic circulation. There is no need to press deeply as the lymph are superficial vessels.
• Cold compresses to the face or backs of the legs with yarrow tea may give temporary relief of edema.
• Contrast hydrotherapy involves alternating hot and cold application to bring nutrients to the site and to diffuse metabolic waste from inflammation. The overall effect is decreased inflammation, pain relief, and enhanced healing. Using this technique with hand and/or foot baths may help to improve circulation and lymphatic drainage. Alternate three minutes hot with one minute cold. Repeat three times to complete one set. Do two to three sets/day. Use caution in areas of decreased sensation by ensuring that the hot application does not burn.

General Recommendations:

• Eat a diet that is high in fiber.
• For protein, eat eggs, broiled white fish, and broiled skinless chicken or turkey. Consume small amounts of buttermilk, cottage cheese, kefir, and low-fat yogurt.
• Use kelp to supply needed minerals.
• Avoid alcohol, animal protein, caffeine, chocolate, dairy products (except those listed above), dried shellfish, fried foods, gravies, olives, pickles, salt, soy sauce, tobacco, white flour and white sugar.
• If you have swelling of the legs and feet, sit with your feet up as often as you can. Wear support hose for swelling in the legs.
• Exercise daily and take hot baths or saunas twice a week.
• Avoid stress.

Warnings:

• If pressing with the fingers on your feet and ankles results in the formation of small "pits", consult your doctor. This can be a sign of a serious health problem.
• If you are pregnant and notice swelling, contact your physician for more information about preeclampsia.