Edema, formerly called dropsy, is the accumulation of fluid in spaces between the cells of the soft tissues of the

body (body tissues or interstitial spaces) which causes the tissues to swell and expand in size. Edema most often occurs in the feet, ankles, and legs, but any part of the body may develop edema. In various diseases, excess fluid can accumulate in either one or both of these compartments. The swelling can be localized in the face, arms and neck, or may involve the legs, ankles and feet, known as dependent edema. The body's organs also have interstitial spaces where fluid can accumulate. For example, an accumulation of fluid in the interstitial air spaces (alveoli) in the lungs occurs in heart failure and is called pulmonary edema. Excess fluid sometimes collects in what has been called the third space, which includes cavities in the abdomen (abdominal or peritoneal cavity) or in the chest (lung or pleural cavity). TYPES OF EDEMA y y y y y Anasarca Edema: Generalized swelling all over the body. Dependent or Peripheral Edema: Swelling in the feet, ankles, and legs. Peri-orbital Edema: Swelling around the eyes. Corneal Edema (Corneal Stroma): Swelling in the cornea of the eye. Preeclampsia: A condition that occurs in 5 percent of pregnant women that results in high blood pressure, edema (fluid accumulation in the tissues) and protein (albuminuria) in the urine.

CAUSES Edema can indicate a much more profound illness, such as AIDS, cirrhosis of the liver, congestive heart failure, diabetes, or vena cava syndrome (narrowing of the vein that supplies blood from the upper body to the heart). More simply, edema can occur as the result of infection or prolonged bed rest. y y y y y y y y y y Edema (fluid retention) may be caused by allergies. Edema may also occur as a result of trauma or surgical procedures. Many women develop some degree of edema during pregnancy. Persistent edema may be caused by kidney, bladder, heart, liver disorders. Poor diet; protein deficiency; sodium retention; poor magnesium/calcium balance; high carbohydrate diet. Drug abuse; over use of laxatives or diuretics, oral contraceptives The edema that occurs in diseases of the heart, liver, and kidneys is mainly caused by salt retention, which holds the excess fluid in the body. In certain liver and kidney diseases, low levels of albumin in the blood can contribute to fluid retention. Cirrhosis of the liver, and a kidney disease called nephrotic syndrome are the most common systemic diseases that cause edema. Varicose veins or thrombophlebitis (a blood clot in an inflamed vein) of the deep veins in the legs causes edema that is localized to the legs.

Therapy for edema consists of treating the underlying conditions, restricting salt intake, and often using diuretics (medicines to induce urination).

SALT INTAKE AND EDEMA A normal person can consume small or large quantities of salt in the diet without concern for developing salt depletion or retention. The intake of salt is determined by dietary patterns and the removal of salt from the body is accomplished by the kidneys. The kidneys have a great capacity to control the amount of salt in the body by changing the amount of salt eliminated (excreted) in the urine. If the flow of blood to the kidneys is decreased by an underlying condition such as heart disease, the kidneys react by retaining salt. This salt retention occurs because the kidneys perceive that the body needs more fluid to compensate for the decreased blood flow. If, on the other hand, the client/patient has a kidney disease that impairs the function of the kidneys, the ability to excrete salt in the urine is limited. In both of these conditions, the amount of salt in the body increases, which causes the client/patient to retain water and develop edema. Clients/Patients experiencing a disturbance in their ability to normally excrete salt may need to either be placed on a diet limited in salt and/or given diuretic medications. HEART DISEASE & FLUID RETENTION Heart disease, poor cardiac function is reflected by a decreased volume of blood pumped out by the heart( cardiac output). The diminished volume of blood pumped out by the heart (decreased cardiac output) is responsible for a decreased flow of blood to the kidneys. As a result, the kidneys sense that there is a reduction of the blood volume in the body. To counter the seeming loss of fluid, the kidneys retain salt and water. The health care provider examining a client/patient who has congestive heart failure with fluid retention looks for certain signs. These include pitting edema of the legs and feet, rales in the lungs (moist crackle sounds from the excess fluid that can be heard with a stethoscope), a gallop rhythm (three heart sounds instead of the normal two due to muscle weakness), and distended neck veins. The distended neck veins reflect the accumulation of blood in the veins that are returning blood to the heart. LIVER DISEASE: DEVELOPING ASCITES & EDEMA In people with chronic diseases of the liver, fibrosis (scarring) of the liver often occurs. When the scarring becomes advanced, the condition is called cirrhosis of the liver. Ascites is fluid that accumulates in the abdominal (peritoneal) cavity. It is a complication of cirrhosis and appears as an abdominal bulge. Ascites develops because of a combination of two factors: (1) Increased pressure in the vein system that carries blood from the stomach, intestines, and spleen to the liver (portal hypertension) (2) A low level of albumin in the blood (hypoalbuminemia). Albumin, which is the predominant protein in the blood and which helps maintain blood volume, is reduced in cirrhosis primarily because the damaged liver is not able to produce enough albumin. Other consequences of portal hypertension include dilated veins in the esophagus (varices), prominent veins on the abdomen, and an enlarged spleen. Each of these conditions is due primarily to the increased pressure and accumulation of blood in the abdominal blood vessels.

Peripheral edema, which is usually seen as pitting edema of the legs and feet, also occurs in cirrhosis. The edema is a consequence of the hypoalbuminemia and activation of the renin-angiotensin- aldosterone hormonal system, which prompt the kidneys to retain salt and water. The presence or absence of edema in patients with cirrhosis and ascites is an important consideration in the treatment of the ascites. In people with ascites without edema, diuretics must be given with extra caution. The reason for this is that a diuresis (induced increased volume of urine) that is too depleting or rapid in these people can lead to a low blood volume (hypovolemia), which can possibly be followed by kidney and liver failure. In contrast, when people who have both edema and ascites undergo diuresis, the edema fluid in the interstitial space serves as somewhat of a buffer against the development

of low blood volume. The excess interstitial fluid moves into the blood vessel spaces to rapidly replenish the depleted blood volume. EDEMA & KIDNEY DISEASE Edema forms in people with kidney disease primarily for one of two reasons: either a heavy loss of protein in the urine or impaired kidney (renal) function. In the first situation, the people have normal or fairly normal kidney function. The heavy loss of protein in the urine (over 3.0 grams per day) is termed the nephrotic syndrome and results in a reduction in the concentration of albumin in the blood (hypoalbuminemia). Since albumin helps to maintain blood volume in the blood vessels, a reduction of fluid in the blood vessels occurs. The kidneys then register that there is depletion of blood volume and, therefore, attempt to retain salt. Consequently, fluid moves into the interstitial spaces, thereby causing pitting edema. The treatment of fluid retention in these people is to reduce the loss of protein into the urine and to restrict salt in the diet. The loss of protein in the urine may be reduced by the use of ACE inhibitors and angiotensin receptor blockers. Both categories of drugs, which ordinarily are used to lower blood pressure, prompt the kidneys to reduce the loss of protein into the urine.

IDIOPATHIC EDEMA Idiopathic edema is a pitting edema of unknown cause that occurs primarily in pre-menopausal women who do not have evidence of heart, liver, or kidney disease. In this condition, the fluid retention at first may be seen primarily pre-menstrually, which is why it sometimes is called cyclical edema. Subsequently, however, it can become a more constant and severe problem. Idiopathic edema is a poorly defined syndrome in which emotional factors may play a role. People with idiopathic edema appear to have a leak in the capillaries (tiny peripheral blood vessels that connect the arteries with the veins) so that fluid passes from the blood vessels into the surrounding interstitial space. Thus, a patient with idiopathic edema has a decreased blood volume, which leads to the typical reaction of salt retention by the kidneys. The leg edema in these people is exaggerated in the standing position, since edema tends to accumulate in those parts of the body that are close to the ground at the time. Likewise, these individuals often have edema around the eyes (periorbital edema) in the morning because the edema fluid accumulates during the night around their eyes as they lay sleeping flat. In contrast, edema around the eyes does not tend to develop in cardiac patients who keep their heads elevated at night because of shortness of breath when they lie flat. These patients characteristically experience varying amounts of edema in different parts of the body at different times of the day.

VENOUS INSUFFICIENCY & EDEMA The veins in the legs are responsible for transporting blood up to the veins of the torso, where it is then returned to the heart. The veins of the legs have valves that prevent the blood from backing up in the veins. Venous insufficiency is incompetence of the veins that occurs because of dilation, or enlargement, of the veins and dysfunction of their valves. This happens, for example, in people with varicose veins. Venous insufficiency leads to a backup of blood and increased pressure in the veins, thereby resulting in edema of the legs and feet. Edema of the legs also can occur with an episode of deep vein thrombophlebitis, which is a blood clot within an inflamed vein. In this situation, the clot in the deep vein blocks the return of blood and consequently causes increased backpressure in the leg veins. Venous insufficiency is a problem that is localized to the legs. One leg may be more affected than the other (asymmetrical edema). In contrast, systemic diseases that are associated with fluid retention generally cause the same amount of edema in both legs, and can also cause edema and swelling elsewhere in the body. The response to therapy with diuretic drugs in patients with venous insufficiency tends to be unsatisfactory. This is because the continued pooling of fluid in the lower extremities makes it difficult for the diuretics to mobilize the edema fluid. Elevation of the legs periodically during the day and the use of compression stockings may alleviate the edema. Some people, however, require surgical treatment to relieve chronic edema that is caused by venous insufficiency.

Edema can occur anywhere in the body, so consider these factors when assessing your client or patient. Disorders such as heart failure and cirrhosis, or local conditions such as venous stasis and poor lymphatic drainage, can cause edema. Edema may be visible and measurable, as in localized or pitting edema, or it may be generalized. TREATMENT The human heart pumps about 5 quarts of blood per minute, circulating nutrients, water and oxygen into even the tiniest capillaries. There, the blood permeates the vessel walls to reach all the body's tissues. When circulation is poor, for whatever reason, fluid builds up in the tissues, a condition called edema. It may the result of blocked venous or lymphatic flow, extreme metabolic wastes or an injury to the lymphatic or blood vessels, which can occur with a burn - even a bad sunburn. Radiation, surgery and trauma to the blood vessels may also cause edema. Circulatory or kidney disease, metabolic disorders and tumors can impede blood flow and cause edema, too. The most common cause of edema, however, is cardiac insufficiency, which is curable. If edema is found early and treated throughout life, improving venous tone, heart-muscle function and fluid excretion may help the condition. If you experience edema swelling, you need to find out the reason for the edema. An early diagnosis is important. Do not limit your water intake; that overworks the kidneys, leads to dehydration and makes the heart work harder. Treatment for the condition includes promoting water excretion and improving circulation. You may need to make some lifestyle changes or take medication to help relieve edema. Edema can be a symptoms of heart failure as well as many other disorders involving the liver and kidneys. BENEFICIAL DIETARY SUPPLEMENTS Vitamin B Complex reduces water retention. Vitamin C with Bioflavonoids improves adrenal function. Calcium, Magnesium and Zinc Complex replaces minerals lost when fighting edema. Kelp improves thyroid function and supplies needed minerals. Bromelain aids digestion and metabolism. Vitamin E aids circulation. Potassium helps keep body fluids in the cell walls. Gravelroot, Cornsilk, Dandelion Root, Butcher's Broom and Marshmallow Root are beneficial in treating edema.