Edema

Unilateral Edema —  r/o Deep Venous Thrombosis (DVT)

BILATERAL EDEMA — TARGET ORGANS FOR WORK-UP

  • Heart Failure
  • Pulmonary Embolism
  • Kidney
  •  Liver
  • Anemia
  • Thyroid

DIAGNOSTIC WORK-UP

1.  History & Physical for clues to:
2.  Order — CBC,  Chemistry Panel,  BNP,  TSH,  U/A, EKG
  • CBC  —  for Anemia (also ↓ Platelets in Cirrhosis)
  • B-Type Natriuretic Peptide (BNP)  —  for CHF
  • Creatinine & BUN  —  for Nephrotic Syndrome / Renal Failure
  • LFTs  —  for Cirrhosis / Liver Failure  (may be deceptively normal)
  • Serum Albumin  —  for Cirrhosis and Nephrotic Syndrome
  • TSH  —  for Hypothyroidism
  • Urinalysis  —  for Nephrotic Proteinuria (causing hypoalbuminemia)
  • EKG  —  for recent MI, a possible cause of new CHF
  • Echocardiogram (consider)  —  if reasonable suspicion of CHF (right- or left-sided)
3.  If Work-Up is Negative, consider:
  • Chronic Venous Insufficiency
  • Medications:
    • Ca++ Channel Blockers, Thioglitazones, NSAIDs, Estrogens
  • Diuretic Dependence (surreptitious use w/ rebound)
  • Persistent Immobile Upright Posture (e.g. sleeps sitting)
  • Late Pregnancy (usually obvious)
  • Severe Malnutrition (usually obvious)
  • “Idiopathic edema”

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