Anasarca: Difference between revisions
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A good mnemonic for anasarka is: Anasarka is like a parka, all over. | A good mnemonic for anasarka is: Anasarka is like a parka, all over. | ||
It is usually caused by either congestive [[cardiac failure]], [[liver failure]] ([[cirrhosis]] of the liver) | It is usually caused by either congestive [[cardiac failure]], [[liver failure]] ([[cirrhosis]] of the liver), [[renal failure]]/disease, or other disease (see below). | ||
It can also be created from the administration of exogenous intravenous fluid. | It can also be created from the administration of exogenous intravenous fluid. | ||
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(In alphabetical order) | (In alphabetical order) | ||
*[[Acute renal failure]] | *[[Acute renal failure]], especially oliguric renal failure with fluid retention | ||
*[[Allergic reactions]] | *[[Allergic reactions]], only systemic severe allergic reactions with associated capillary leak | ||
*[[Angioedema]] | *[[Angioedema]], rarely, when it is severe and generalized angioedema | ||
*[[Burns]] | *[[Burns]] generalized severe burns can result in [[Hypoalbuminemia]] and capillary leak | ||
*[[Calcium channel blockers]] | *[[Calcium channel blockers]] usually cause localized edma and not anasarca | ||
*[[Capillary leak syndrome]] | *[[Capillary leak syndrome]] | ||
*[[Cardiac tamponade ]] | *[[Cardiac tamponade ]] resulting in heart failure and generalized edema | ||
*[[Chronic kidney disease]] | *[[Chronic kidney disease]] advanced stages with fluid retention | ||
*[[Constrictive pericarditis]] | *[[Constrictive pericarditis]] with associated heart failure | ||
*[[Cor pulmonale]] | *[[Cor pulmonale]] resulting in right heart failure | ||
*[[Diazoxide]] | *[[Diazoxide]] usually cause localized edma and not anasarca | ||
*[[Dilated cardiomyopathy]] | *[[Dilated cardiomyopathy]] | ||
*[[Docetaxel]] | *[[Docetaxel]] usually cause localized edma and not anasarca | ||
*[[Eclampsia]] | *[[Eclampsia]] (severe eclampsia) | ||
*[[Effusive-constrictive pericarditis]] | *[[Effusive-constrictive pericarditis]] with associated heart failure | ||
*[[Estrogens]] | *[[Estrogens]] | ||
*[[Fludrocortisone]] | *[[Fludrocortisone]] | ||
*[[Glomerulonephritis]] | *[[Glomerulonephritis]] | ||
*[[Haemolytic disease of the newborn]] | *[[Haemolytic disease of the newborn]] | ||
*[[Heart failure]] | *[[Heart failure]] | ||
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**[[Non-alcoholic fatty liver disease|Nonalcoholic fatty liver disease]] | **[[Non-alcoholic fatty liver disease|Nonalcoholic fatty liver disease]] | ||
**[[Wilson's disease]] | **[[Wilson's disease]] | ||
*[[Hereditary angioedema]] | *[[Hereditary angioedema]] in severe cases | ||
*[[Hypertrophic cardiomyopathy]] | *[[Hypertrophic cardiomyopathy]] | ||
*[[Hypoalbuminemia]] | *[[Hypoalbuminemia]] | ||
*[[Hypoproteinemia]] | *[[Hypoproteinemia]] | ||
*[[Hypothyroidism]] | *[[Hypothyroidism]] in advanced untreated hypothyroidism | ||
*Idiopathic [[edema]] | *Idiopathic [[edema]] | ||
*Increased capillary permeability | *Increased capillary permeability | ||
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*[[Interleukin-2]] therapy | *[[Interleukin-2]] therapy | ||
*[[Kwashiorkor]] | *[[Kwashiorkor]] | ||
*Lymphatic obstruction | *Lymphatic obstruction usually cause localized limb edema unless very proximal | ||
*[[Malnutrition]] | *[[Malnutrition]] | ||
*[[Malignant ascites]] | *[[Malignant ascites]] associated with lower extremities edema | ||
*[[Minoxidil]] | *[[Minoxidil]] usually causes localized edema to the lower extremities | ||
*[[Nephrotic syndrome]] | *[[Nephrotic syndrome]] | ||
*[[Nonsteroidal antiinflammatory drug]] causes localized edma | |||
*[[Nonsteroidal antiinflammatory drug]] | |||
*[[Ovarian hyperstimulation syndrome]] | *[[Ovarian hyperstimulation syndrome]] | ||
*[[POEMS syndrome]] | *[[POEMS syndrome]] | ||
*[[Portal thrombosis]] | *[[Portal thrombosis]] causes lower extremities edema | ||
*[[Pramipexole]] | *[[Pramipexole]] | ||
*[[Pregnancy]] | *[[Pregnancy]] | ||
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*Sodium overload | *Sodium overload | ||
*[[Thiazolidinediones]] | *[[Thiazolidinediones]] | ||
*[[Trauma]] | *[[Trauma]] (severe trauma) | ||
*[[Tricuspid stenosis]] | *[[Tricuspid stenosis]] | ||
*[[Tropical sprue]] | *[[Tropical sprue]] | ||
*Venous obstruction | *Venous obstruction usually causes localized edema | ||
*Water overload | *Water overload | ||
*[[Yellow nail syndrome]] | *[[Yellow nail syndrome]] | ||
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=='''Treatment'''== | |||
The treatment of anasraca depends on the underlying cause. It involves the use of diuretics in cases related to heart failure or kidney disease. The latter may require hemodialysis especially if there are signs or symptoms of uremia. In cases of severe burns resulting in hypoalbuminemia and capillary leak, admission to a burn unit, volume and electrolytes replacement, and adequate nutrition is of paramount. Withdrawal of the offending drug is needed in drug-induced edema. The use of diuretics, paracentesis, and adequate nutritional supplementation is needed in anasarc secondary to hepatic cirrhosis. Profound hypothyroidism requires thyroid hormone replacement. Protein malabsorption syndromes require the identification of the underlying disease process and adequate protein supplementation. | |||
[[User:Johnfanisrour|Johnfanisrour]] 20:17, 15 January 2009 (UTC)John Fani Srour[[User:Johnfanisrour|Johnfanisrour]] 20:17, 15 January 2009 (UTC) | [[User:Johnfanisrour|Johnfanisrour]] 20:17, 15 January 2009 (UTC)John Fani Srour[[User:Johnfanisrour|Johnfanisrour]] 20:17, 15 January 2009 (UTC) | ||
Revision as of 15:44, 25 January 2009
| Anasarca | |
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| ICD-10 | R60.1 |
| ICD-9 | 782.3 |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Please Take Over This Page and Apply to be Editor-In-Chief for this topic: There can be one or more than one Editor-In-Chief. You may also apply to be an Associate Editor-In-Chief of one of the subtopics below. Please mail us [2] to indicate your interest in serving either as an Editor-In-Chief of the entire topic or as an Associate Editor-In-Chief for a subtopic. Please be sure to attach your CV and or biographical sketch.
Overview
Anasarca (or "extreme generalized edema") is a medical symptom characterized by widespread swelling of the skin due to effusion of fluid into the extracellular space.
A good mnemonic for anasarka is: Anasarka is like a parka, all over.
It is usually caused by either congestive cardiac failure, liver failure (cirrhosis of the liver), renal failure/disease, or other disease (see below).
It can also be created from the administration of exogenous intravenous fluid.
Certain plant-derived anticancer chemotherapeutic agents, such as docetaxel, cause anasarca through a poorly understood capillary leak syndrome.
This symptom is also called leucophlegmatia.
Complete Differential Diagnosis of the Causes of Anasarca:
(In alphabetical order)
- Acute renal failure, especially oliguric renal failure with fluid retention
- Allergic reactions, only systemic severe allergic reactions with associated capillary leak
- Angioedema, rarely, when it is severe and generalized angioedema
- Burns generalized severe burns can result in Hypoalbuminemia and capillary leak
- Calcium channel blockers usually cause localized edma and not anasarca
- Capillary leak syndrome
- Cardiac tamponade resulting in heart failure and generalized edema
- Chronic kidney disease advanced stages with fluid retention
- Constrictive pericarditis with associated heart failure
- Cor pulmonale resulting in right heart failure
- Diazoxide usually cause localized edma and not anasarca
- Dilated cardiomyopathy
- Docetaxel usually cause localized edma and not anasarca
- Eclampsia (severe eclampsia)
- Effusive-constrictive pericarditis with associated heart failure
- Estrogens
- Fludrocortisone
- Glomerulonephritis
- Haemolytic disease of the newborn
- Heart failure
- Hepatic cirrhosis
- Hereditary angioedema in severe cases
- Hypertrophic cardiomyopathy
- Hypoalbuminemia
- Hypoproteinemia
- Hypothyroidism in advanced untreated hypothyroidism
- Idiopathic edema
- Increased capillary permeability
- Increased interstitial oncotic pressure
- Interleukin-2 therapy
- Kwashiorkor
- Lymphatic obstruction usually cause localized limb edema unless very proximal
- Malnutrition
- Malignant ascites associated with lower extremities edema
- Minoxidil usually causes localized edema to the lower extremities
- Nephrotic syndrome
- Nonsteroidal antiinflammatory drug causes localized edma
- Ovarian hyperstimulation syndrome
- POEMS syndrome
- Portal thrombosis causes lower extremities edema
- Pramipexole
- Pregnancy
- Protein loss
- Protein-losing enteropathy
- Reduced albumin synthesis
- Refeeding edema
- Restrictive cardiomyopathy
- Severe inflammation or sepsis
- Sodium overload
- Thiazolidinediones
- Trauma (severe trauma)
- Tricuspid stenosis
- Tropical sprue
- Venous obstruction usually causes localized edema
- Water overload
- Yellow nail syndrome
Complete Differential Diagnosis of the Causes of Anasarca:
(By organ system)
| Cardiovascular | Cardiac tamponade ,
Constrictive pericarditis, Cor pulmonale, Dilated cardiomyopathy, Effusive-constrictive pericarditis, Heart failure, Hypertrophic cardiomyopathy, Restrictive cardiomyopathy, Tricuspid stenosis |
| Chemical / poisoning | No underlying causes |
| Dermatologic | No underlying causes |
| Drug Side Effect | Calcium channel blockers, Diazoxide, Docetaxel, Estrogens
Fludrocortisone, Interleukin-2 therapy, Minoxidil, Nonsteroidal antiinflammatory drugs |
| Ear Nose Throat | No underlying causes |
| Endocrine | No underlying causes |
| Environmental | No underlying causes |
| Gastroenterologic | Alcoholic liver disease , Autoimmune hepatitis, Chronic hepatitis B, Chronic hepatitis C, Hepatic cirrhosis, Hepatic venous obstruction, Hereditary hemochromatosis, Portal thrombosis, Primary biliary cirrhosis, Primary sclerosing cholangitis, Wilson's disease |
| Genetic | Angioedema, Alpha-1-antitrypsin deficiency, Hereditary angioedema
Hereditary hemochromatosis, Hypertrophic cardiomyopathy, Wilson's disease, Yellow nail syndrome |
| Hematologic | No underlying causes |
| Iatrogenic | No underlying causes |
| Infectious Disease | Tropical sprue |
| Musculoskeletal / Ortho | No underlying causes |
| Neurologic | No underlying causes |
| Nutritional / Metabolic | Hypoalbuminemia, Hypoproteinaemia, Kwashiorkor, Malnutrition
Protein loss, Protein-losing enteropathy, Reduced albumin synthesis, Refeeding edema, Sodium overload, Tropical sprue, Water overload |
| Obstetric/Gynecologic | Eclampsia, Estrogens, Haemolytic disease of the newborn, Ovarian hyperstimulation syndrome, Pregnancy |
| Oncologic | Malignant ascites |
| Opthalmologic | No underlying causes |
| Overdose / Toxicity | No underlying causes |
| Psychiatric | No underlying causes |
| Pulmonary | No underlying causes |
| Renal / Electrolyte | No underlying causes |
| Rheum / Immune / Allergy | Haemolytic disease of the newborn, Autoimmune hepatitis |
| Sexual | No underlying causes |
| Trauma | Trauma |
| Urologic | No underlying causes |
| Miscellaneous | No underlying causes |
Treatment
The treatment of anasraca depends on the underlying cause. It involves the use of diuretics in cases related to heart failure or kidney disease. The latter may require hemodialysis especially if there are signs or symptoms of uremia. In cases of severe burns resulting in hypoalbuminemia and capillary leak, admission to a burn unit, volume and electrolytes replacement, and adequate nutrition is of paramount. Withdrawal of the offending drug is needed in drug-induced edema. The use of diuretics, paracentesis, and adequate nutritional supplementation is needed in anasarc secondary to hepatic cirrhosis. Profound hypothyroidism requires thyroid hormone replacement. Protein malabsorption syndromes require the identification of the underlying disease process and adequate protein supplementation.
Johnfanisrour 20:17, 15 January 2009 (UTC)John Fani SrourJohnfanisrour 20:17, 15 January 2009 (UTC)