General principles of the treatment of edema in adults
- Richard H Sterns, MD
Richard H Sterns, MD
- Section Editor — Fluid and Electrolytes
- Professor of Medicine
- University of Rochester School of Medicine and Dentistry
- Section Editors
- Michael Emmett, MD
Michael Emmett, MD
- Editor-in-Chief — Nephrology
- Section Editor — Fluid and Electrolytes
- Chief of Internal Medicine
- Baylor University Medical Center
- Robert H Fletcher, MD, MSc
Robert H Fletcher, MD, MSc
- Editor-in-Chief — Adult Primary Care
- Section Editor — General Medicine
- Professor Emeritus of Population Medicine
- Harvard Medical School
Edema is defined as a palpable swelling produced by expansion of the interstitial fluid volume; when massive and generalized, the excess fluid accumulation is called anasarca. A variety of clinical conditions are associated with the development of edema, including heart failure, cirrhosis, and the nephrotic syndrome, as well as local conditions such as venous and lymphatic disease or malignant ascites (table 1). (See "Pathophysiology and etiology of edema in adults".)
The general principles for the treatment of edema in adults, including the use of diuretics to remove the excess fluid, will be reviewed here. The specific effects of diuretics in the three major generalized edema states (heart failure, cirrhosis, and the nephrotic syndrome), the clinical features and diagnosis of the generalized edematous states, and the treatment of refractory edema are discussed separately. (See "Use of diuretics in patients with heart failure" and "Ascites in adults with cirrhosis: Initial therapy", section on 'Diuretic therapy' and "Pathophysiology and treatment of edema in patients with the nephrotic syndrome" and "Clinical manifestations and diagnosis of edema in adults" and "Treatment of refractory edema in adults".)
GENERAL PRINCIPLES OF THERAPY
Treatment of edema consists of reversal of the underlying disorder (if possible), dietary sodium restriction (to minimize fluid retention), and, in most patients, diuretic therapy. Before initiating diuretic therapy, it is important to consider the following questions, which apply to all edematous states:
●When must edema be treated?
●What are the consequences of the removal of edema fluid?
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- GENERAL PRINCIPLES OF THERAPY
- When must edema be treated?
- What are the consequences of the removal of edema fluid?
- How rapidly should edema fluid be removed?
- Venous insufficiency, lymphedema, and malignant ascites
- USE OF DIURETICS
- Choice of loop diuretic
- Diuretic dose
- Time course of diuretic response
- Refractory edema
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS