Anasarca is a severe and generalized form of

edema Edema (American English), also spelled oedema (British English), and also known as fluid retention, swelling, dropsy and hydropsy, is the build-up of fluid in the body's tissue (biology), tissue. Most commonly, the legs or arms are affected. S ...

, with subcutaneous tissue swelling throughout the body. Unlike typical

, which almost everyone will experience at some time and can be relatively benign, anasarca is a pathological process reflecting a severe disease state and can involve the cavities of the body in addition to the tissues.

Signs and symptoms

Physical appearance

Can include: * Periorbital edema "

eye puffiness Periorbital puffiness, also known as puffy eyes, or swelling around the eyes, is the appearance of swelling in the tissues around the eyes, called the orbits. It is almost exclusively caused by fluid buildup around the eyes, or periorbital edema ...

" * Perioral

* Upper extremity

Ascites Ascites (; , meaning "bag" or "sac") is the abnormal build-up of fluid in the abdomen. Technically, it is more than 25 ml of fluid in the peritoneal cavity, although volumes greater than one liter may occur. Symptoms may include increased abdo ...

* Lower extremity

* Pre-tibial

Pedal edema Edema (American English), also spelled oedema (British English), and also known as fluid retention, swelling, dropsy and hydropsy, is the build-up of fluid in the body's tissue. Most commonly, the legs or arms are affected. Symptoms may inclu ...

Physical manifestations

Can include: * Impaired vision, difficulty opening eyes * Shortness of breath (SOB),

dyspnea Shortness of breath (SOB), known as dyspnea (in AmE) or dyspnoea (in BrE), is an uncomfortable feeling of not being able to breathe well enough. The American Thoracic Society defines it as "a subjective experience of breathing discomfort that ...

on exertion (DOE),

orthopnea Orthopnea or orthopnoea is shortness of breath (dyspnea) that occurs when lying flat, causing the person to have to sleep propped up in bed or sitting in a chair. It is commonly seen as a late manifestation of heart failure, resulting from fluid ...

* Chest pain * Extreme discomfort * Debilitation

Cause

Anasarca is often caused by a decreased

oncotic pressure Oncotic pressure, or colloid osmotic-pressure, is a type of osmotic pressure induced by the plasma proteins, notably albumin, in a blood vessel's plasma (or any other body fluid such as blood and lymph) that causes a pull on fluid back into ...

Organ failure

Liver failure Liver failure is the inability of the liver to perform its normal synthetic and metabolic functions as part of normal physiology. Two forms are recognised, acute and chronic (cirrhosis). Recently, a third form of liver failure known as acute- ...

Kidney failure Kidney failure, also known as renal failure or end-stage renal disease (ESRD), is a medical condition in which the kidneys can no longer adequately filter waste products from the blood, functioning at less than 15% of normal levels. Kidney fa ...

* Right-sided

heart failure Heart failure (HF), also known as congestive heart failure (CHF), is a syndrome caused by an impairment in the heart's ability to Cardiac cycle, fill with and pump blood. Although symptoms vary based on which side of the heart is affected, HF ...

Malignancy

Diet

* Severe protein deficiency

Systemic manifestations of

Nephrotic syndrome Nephrotic syndrome is a collection of symptoms due to kidney damage. This includes proteinuria, protein in the urine, hypoalbuminemia, low blood albumin levels, hyperlipidemia, high blood lipids, and significant edema, swelling. Other symptoms ...

* Protein-losing enteropathies * Capillary leak syndrome

In utero

In Hb Barts, the high oxygen affinity results in poor oxygen delivery to peripheral tissues, resulting in anasarca.

Iatrogenic

It can also be caused by the administration of

exogenous In a variety of contexts, exogeny or exogeneity () is the fact of an action or object originating externally. It is the opposite of endogeneity or endogeny, the fact of being influenced from within a system. Economics In an economic model, an ...

intravenous Intravenous therapy (abbreviated as IV therapy) is a medical technique that administers fluids, medications and nutrients directly into a person's vein. The intravenous route of administration is commonly used for rehydration or to provide nutr ...

fluid.

Diagnosis

Anasarca is a diagnosis made clinically and differentiated from

by extent of body involvement and severity. Whereas

is usually graded on a mild/moderate/severe scale and usually affects one or two regions of the body, anasarca affects the entire body and is the most severe form of

, with subcutaneous tissue swelling from head to feet.

Testing

Although there is no definitive test to prove anasarca, many tests can be useful to aid in the diagnosis. Anasarca is most often seen in conjunction with a low level of

albumin Albumin is a family of globular proteins, the most common of which are the serum albumins. All of the proteins of the albumin family are water- soluble, moderately soluble in concentrated salt solutions, and experience heat denaturation. Alb ...

A research paper published in 2001 demonstrated a linkage between low-voltage electrocardiogram (ECG) (LVE) (QRS complexes of <5 mm in the limb and <10 mm in the precordial leads) and Anasarca.

Treatment

Anasarca is a severe symptom, not a pathological process in and of itself; as such, the best treatment is to treat the underlying cause. However, there are a number of things that can be done to help get the fluid off as well as prevent further accumulation of fluid.

Diuretics

One of the mainstays of any edema treatment, diuretics are a category of medications that help the body excrete fluid by altering the way in which the kidney processes urine. *

Loop diuretic Loop diuretics are pharmacological agents that primarily inhibit the Na-K-Cl cotransporter located on the luminal membrane of cells along the thick ascending limb of the loop of Henle. They are often used for the treatment of hypertension and e ...

s *

Thiazide Thiazide () refers to both a class of sulfur-containing organic molecules and a class of diuretics based on the chemical structure of benzothiadiazine. The thiazide drug class was discovered and developed at Merck and Co. in the 1950s. The firs ...

diuretics * Thiazide-like diuretics *

Potassium-sparing diuretic Potassium-sparing diuretics or antikaliuretics refer to drugs that cause diuresis without causing potassium loss in the urine. They are typically used as an adjunct in management of hypertension, cirrhosis, and congestive heart failure. The ster ...

Diet

The body more efficiently absorbs fluid from the gut and retains that fluid with the help of

sodium Sodium is a chemical element; it has Symbol (chemistry), symbol Na (from Neo-Latin ) and atomic number 11. It is a soft, silvery-white, highly reactive metal. Sodium is an alkali metal, being in group 1 element, group 1 of the peri ...

and

sugar Sugar is the generic name for sweet-tasting, soluble carbohydrates, many of which are used in food. Simple sugars, also called monosaccharides, include glucose Glucose is a sugar with the Chemical formula#Molecular formula, molecul ...

. As such, decreasing salt and simple sugar intake will help prevent accumulation of fluid and potentiate the effect of any diuretics. Following a high protein diet will help provide one's body with the substrates necessary to produce

, the major protein in human plasma and the single most important molecule in maintaining the serum

Fiber

Bulking fiber, both soluble and insoluble

dietary fiber Dietary fiber (fibre in English in the Commonwealth of Nations, Commonwealth English) or roughage is the portion of plant-derived food that cannot be completely broken down by human digestive enzymes. Dietary fibers are diverse in chemical co ...

, absorb water throughout the GI tract.Viscous fiber can thicken the contents of the GI track and slow the absorption of other compounds (like simple sugars).

References

External links

{{Disorders of volume state Medical signs Symptoms and signs: Skin and subcutaneous tissue