Anasarca

Definition

It is common to have swelling of the body and many things cause the problem including diet, medication, pregnancy, menstruation, overhydration, an underlying medical condition, or injury. When you have localized body swelling, it may be referred to as edema. In most cases, edema affects parts of the body like feet, ankles, arms, hands, legs, or any other body part. Sometimes, edema becomes so severe that the whole body swells. If that happens, you find that the skin and the tissues underlying it begin to retain salt and water. This causes the entire body to swell and it may be referred to as anasarca or extreme generalized edema.

A person with anasarca may have difficulties in movement because of the extreme swelling. Often, when anasarca manifests, it may indicate a serious illness or severe organ damage. ^1,2,3,4

 

Anasarca Pathophysiology

To help you understand why there is fluid retention occurring between cells, you should first learn the body hemodymanics. You know that blood flows through a network of vessels which include veins, arteries, venules, arterioles, and capillaries. Although blood is in form of fluid, it comprises many elements including cells, proteins, and other substances.

Capillaries have tiny openings that can allow fluid part of the blood or serum to seep through and enter the interstitial space, or the space between cells. The semi-permeable nature of the capillaries can be associated with fluid accumulation in body tissues. When fluid moves outside the capillaries, it enters the tissue. Hymodynamic forces help to keep or contain the fluid part of the blood in capillaries.

The hemodynamic forces work as follows:⁵

• There is non-fluid part of the blood which puts oncotic pressure to prevent fluid from getting out of the capillaries
• There is hydrostatic pressure found within capillaries and it helps to move blood forward. As the hydrostatic pressure pushes blood forward, it also pushes it onto the walls of the capillaries. This may lead to small volumes of fluid seeping out from the capillaries. However, there is usually a balance between hydrostatic pressure and oncotic pressure that prevents excessive outflow of the fluids from capillaries.
• There is sodium content found in the interstitial space. This is the space that is found between cells located outside the capillaries. The sodium content helps to determine what amount of fluid remains in the interstitial space. If there is excess amount of sodium within the interstitial space, it tends to retain more fluid.
• The lymphatic system is responsible for removing excess fluid found in the interstitial space and it moves it back to the blood.

If there are changes in the hemodynamics, it can result in build-up of fluid in the interstitial space. Hymodynamic changes that may cause generalized edema or anasarca include:⁵

• Increased hydrostatic pressure occurring inside the capillaries
• Reduced oncotic pressure occurring inside the capillaries
• Retention of sodium and water by the kidneys
• Increased permeability of blood capillaries
• Blocking of the lymphatic channels

Causes of Anasarca

Severe generalized edema or anasarca may arise due to various things. Some conditions causing anasarca are common but there are others that are rare. Common causes include:¹

Kidney disease

Kidneys help filter waste and remove excess fluid in the body. When the function of the kidneys is impaired, you may have body fluid not being removed as required leading to excessive fluid retention and the subsequent body swelling in the entire body.

Excessive intravenous fluids

Administration of IV fluids is offered in hospitals to help treat many conditions like dehydration, shock, and infection. Sometimes, the body may not be able to adapt to the fluids it is given resulting in serious edema.

Cirrhosis

Liver disease or failure may cause cirrhosis. When you have liver disease, it brings changes within the hormones something that affects how the body regulates fluids. If your liver is not working efficiently, it may allow fluids to leak and get into the tissues leading to anasarca.

Impaired heart function

Your heart may not function properly if the muscles aren’t working correctly. This affects the ability of the heart to pump blood to other parts of the body. If the heart inefficiently pumps blood, it may cause fluids to start building up in body tissues. When the fluid build-up occurs for a long time, you find that the body swells.

Malnutrition

Having protein deficiency in your diet may make fluids to accumulate or build up in tissues. If this happens for long, it can result in generalized body swelling.

Allergic reaction

Some allergy reactions may cause severe swelling of body.

There are other causes of anasarca that are rare and they include:¹

Capillary leak syndrome

When fluid and protein leak out and move from blood vessels to enter the tissues, it may be referred to as capillary leak syndrome. It is not clearly understood why capillary leak syndrome occurs, however, it is thought to arise due to blood vessel injury and inflammation. This condition has been reported in people taking certain medications or in people who take toxic substance. A study that examined uncontrolled anasarca showed that capillary leak syndrome may arise because of use of certain cancer medications, for example gemcitabine².

Medication side effects

Drugs used to treat diseases and illnesses may have side effects like swelling of the body or anasarca. Common medications that cause generalized body swelling include blood pressure drugs like amlodipine. Sterioids may also cause swelling of body. Often, when a patient discontinues taking the medications, the symptoms associated with anasarca tend to resolve.

Anasarca may also be caused by POEMS syndrome, hookworm, eclampsia or pre-eclampsia, congestive or chronic heart failure, systemic amyloidosis or abnormal build up of protein in the organs, and extreme protein deficiency. ⁴

Symptoms of Anasarca

A person having anasarca will show body swelling. The swelling occurs in the entire body and the skin tends to look stretched and shiny. At times, the severe swelling makes it difficult for an individual to move. At other times, the swelling is extremely severe such that fluid begins to leak out from the patient’s skin. If fluid is directly leaking out from the individual’s skin, the condition is referred to as weeping edema. The person may also develop pitting edema, which occurs due to pressure being exerted to the swelling skin. In this case, when you press and release the skin, an indentation or a dimple is left.

Other symptoms may occur along with swelling and they include:^1,3

• Increased heart rate
• Difficulty lifting arms
• Problems in walking if you have swollen legs
• Aching joints
• Trouble with breathing
• Changes in blood pressure- high or low
• Failing of organ systems, especially kidneys and liver

If fluid builds-up in the lungs, it can result in a life-threatening complication known as pulmonary edema. This is a medical emergency and should be treated immediately. A person with pulmonary edema will have symptoms like chest pain, coughing, and shortness of breath.

Extreme cases of anasarca are debilitating and if there is swelling in your face, it may impair your vision, making it difficult for you to open the eyes.

Diagnosis of Anasarca

When a patient is taken to the doctor, he or she will conduct a physical exam to diagnose the disorder. In severe cases of edema, the doctor is able to recognize anasarca instantly. Further tests may be required to find out the root or underlying cause of the generalized edema.^1,3

A blood sample is taken for testing and it is the initial step in the making of a diagnosis in case of anasarca. Blood testing is done to examine the function of organs like the liver, kidneys, lungs, and heart. A medical history of the patient helps the doctor to determine if there may be a medical condition contributing to the build-up of fluid.

Other tests like imaging tests may be done to help evaluate the organs and tissues. Imaging tests include chest X-ray and echocardiogram (heart ultrasound). CT scans help to examine the chest cavity – lungs, heart, and the associated anatomy.

Stress test helps evaluate lung and heart function while allergy tests helps determine if allergy is causing accumulation of fluids.

Treatment of Anasarca

For a doctor to treat anasarca, he or she will have to use results and reports obtained after diagnosis tests. It will help determine the underlying condition so that proper treatment is applied. When you have proper diagnosis and treatment of the underlying condition causing anasarca, it will with time go away. ³

Doctors may use drugs to expel fluid through the urine if a patient has a severe case of anasarca. The drugs used are known as diuretics and they include furosemide (a loop diuretic).³

Diuretics help the kidney to release more salt to the urine, and this makes the body to release more fluid through urine. Common types of diuretics that doctors prescribe to treat anasarca are loop diuretics and potassium-sparing diuretics. These drugs are taken by mouth, but they may also be given intravenously. A doctor will choose the type of diuretic, the route of administration, and the dose depending on the severity of the body swelling and the condition causing the generalized edema.¹

If anasarca occurs because of poor nutrition, albumin replacement may help in treatment. Albumin is a protein that is synthesized in the body and it is important for various functions such as balancing of fluids in the body. A person with poor nutrition or other serious conditions that lower the level of albumin may have body swelling. The fluid within the bloodstream may be pushed out to enter the tissues thus causing body swelling. So replacement of albumin may correct the problem.¹

Home Treatment

A patient may need to observe home-care tips to help hasten the treatment. The individual should maintain movement by exercising the body to help in pumping excess fluid to the heart. However, in people who have heart problems, they should consult with their doctor before they can start any form of exercise.

Massaging the body gently in the direction of the heart helps reduce swelling. A person may also want to reduce their salt intake because salt contributes to fluid retention in the body.

Conclusion

Anasarca may interfere with the ability of a person to perform their everyday activities. It can decrease the quality of life the people lead. However, when there is proper treatment, it is possible to get rid of the swelling. If the underlying cause is not treated, generalized edema may return. The outlook of patients with the condition depends on how effective the diagnosis and treatment are. In most cases, by the time generalized edema or anasarca has developed, usually the underlying cause has advanced to a critical stage. Problems with the organs like liver, kidneys, lungs, and heart are best addressed when they are treated early. This helps prevent and control anasarca.

Reference List

1. What is anasarca? https://www.medicalnewstoday.com/articles/320906.php
2. Case Report: Uncontrolled Anasarca: Capillary Leak http://jdc.jefferson.edu/cgi/viewcontent.cgi?article=1349&context=tmf
3. https://www.healthline.com/health/anasarca
4. Anasarca: Definition, Causes & Treatment. https://study.com/academy/lesson/anasarca-definition-causes-treatment.html
5. Anasarca. https://emedicalupdates.com/anasarca/