Edema

Edema is defined as the accumulation of excessive amounts of fluid in the cells and tissues of the body and is relatively rare in children. It is usually generalized and dependent (i.e., fluid tends to accumulate in the most dependent areas, such as the lower extremities).

Differential Diagnosis

• Kidney disease (nephrotic syndrome)
  –Insidious onset, periorbital and lower extremity edema, abdominal distension
  –Various types include minimal change disease (MCNS), focal segmental glomerulosclerosis, acute and chronic glomerulonephritis
• Chronic renal failure from any cause may result in impaired fluid excretion
• Liver disease from any cause resulting in impaired production of albumin
• Congestive heart failure (CHF)
• Protein losing enteropathy
  –Menetrier disease (typically CMV), inflammatory bowel disease, neuroblastoma, intestinal lymphangiectasia, trypsinogen deficiency
• Celiac disease
• Sepsis, with capillary leak (movement of fluid out of the blood vessels into the interstitium)
• Hereditary angioneurotic edema
  –Intermittent swelling of extremities
  –Often preceded by trauma
  –Decreased C4 and C1 esterase inhibitor
• Rocky Mountain spotted fever
• Stevens-Johnson syndrome
• Vitamin E deficiency
• Hypothyroidism
• Severe malnutrition
  –Marasmus (calorie deficiency)
  –Kwashiorkor (protein deficiency)
• Zinc deficiency
• Hydrops fetalis
• Impaired lymphatic drainage
  –Milroy disease
  –Meigs syndrome
  –Yellow nail syndrome
  –Lymphedema praecox
• Filariasis (nematode infection resulting in elephantiasis)
• Immobility including placement of body casts and paralysis

Workup and Diagnosis

• History
  –Onset, duration, severity
  –History of heart, kidney, or liver disease; GI bleeding, hypertension, weight gain, feeding intolerance
  –Chest pain, shortness of breath, orthopnea (cardiac disease), jaundice, acholic stools, abdominal distension, GI bleeding (liver disease), oliguria, facial edema, headache or vision changes (hypertension), diarrhea, fever

• Physical exam
  –Blood pressure (hypo- or hypertension), cardiac exam (JVD, murmur)
  –Hepatomegaly, splenomegaly, ascites, scleral icterus
  –Periorbital, lower extremity or presacral edema, abdominal distension, poor peripheral perfusion

• Labs
  –Urinalysis (no proteinuria excludes renal protein loss)
  –Serum chemistries: Albumin, triglycerides, liver transaminases
  –Stool for α-1 antitrypsin for protein-losing enteropathy
  –Prothrombin time (impaired hepatic function)

• Abdominal ultrasound (for liver or kidney disease)
• Studies depending on clinical situation
  –Echocardiogram/ECG for cardiac failure
  –Renal biopsy (if kidney disease other than MCNS is suspected)
  –GI imaging or endoscopy

Treatment

• Nephrotic syndrome
  –Younger children treat with empiric corticosteroid
  –Older children or those with atypical features of MCNS: Renal biopsy with treatment based on results
• Edema related to chronic renal failure
  –Treat with loop diuretics (e.g., furosemide)
  –Other diuretics are ineffective due to renal impairment
• Severe symptomatic edema
  –Treat with IV albumin/furosemide (or other diuretics)
  –Use with caution in patients with oliguria or renal insufficiency, because pulmonary edema could result
• Edema related to liver disease
  –Aldosterone inhibitors (spironolactone) may help
• Sepsis
  –Antibiotics/antivirals
  –Blood pressure support with IVF and/or pressors
  –Additional intensive care support

Book Source Details

• Book Title: In A Page: Pediatric Signs and Symptoms
• Author(s): Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
• Year of Publication: 2007
• Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.

Other Book Chapters Related to Swollen glands

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Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2008 Williams & Wilkins.

More About Causes of Swollen glands

• Back to symptom: Swollen glands: Introduction (review 371 causes)
• Next Book Extract About Swollen glands: Periorbital Edema (In A Page: Pediatric Signs and Symptoms)
• All Book Extracts: All Online Book Extracts for Swollen glands

More About This Book: Title: In A Page: Pediatric Signs and Symptoms Authors: Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-4051-0427-9

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• Periorbital Edema (In A Page: Pediatric Signs and Symptoms)
• PERIORBITAL AND FACIAL EDEMA (Differential Diagnosis in Primary Care)
• EDEMA OF THE EXTREMITIES (Differential Diagnosis in Primary Care)
• Edema of the arm (Handbook of Signs & Symptoms (Third Edition))
• Edema of the leg (Handbook of Signs & Symptoms (Third Edition))

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