Anasarca is a severe and generalized form of edema, with subcutaneous tissue swelling throughout the body.Vinay Kumar, Abbas. Robbins and Cotran Pathologic Basis of Disease. 8th ed. p.112; Philadelphia: Saunders Elsevier, 2010. Unlike typical edema, 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" Perioral edema Upper extremity edema Ascites Lower extremity edema Pre-tibial edema Pedal edema
Physical manifestations Can include: Impaired vision, difficulty opening eyes Shortness of breath (SOB), dyspnea on exertion (DOE), orthopnea Chest pain Extreme discomfort Debilitation
Cause Anasarca is often caused by a decreased oncotic pressure.
Organ failure Liver failure Kidney failure Right-sided heart failure
Malignancy Diet Severe protein deficiency
Systemic manifestations of Nephrotic syndrome 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 intravenous fluid.
Diagnosis Anasarca is a diagnosis made clinically and differentiated from edema by extent of body involvement and severity. Whereas edema is usually graded on a mild/moderate/severe scale and usually affects one or two regions of the body, anasarca affects the several of the body and is the most severe form of edema, 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.
A research paper published in 2001 demonstrated a linkage between low-voltage ECG (QRS complexes of <5 mm in the limb and <10 mm in the precordial leads) and anasarca. Measurement of voltages in millimetres (mm) is a clinical usage based on the standard ECG format.
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 diuretics Thiazide diuretics Thiazide-like diuretics Potassium-sparing diuretics
Diet The body more efficiently absorbs fluid from the gut and retains that fluid with the help of sodium and sugar. As such, decreasing salt and simple sugar intake will help prevent the 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 albumin, the major protein in human plasma and the single most important molecule in maintaining the serum oncotic pressure.
Fiber Bulking fiber, both soluble and insoluble dietary fiber, absorbs water throughout the GI tract. Viscous fiber can thicken the contents of the GI tract and slow the absorption of other compounds (like simple sugars).
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