Dangers of Edema | Severe Edema & Edema Causes

Edema is the medical word for swelling in your body’s tissues, caused by excess fluid that has abnormally left the body’s blood vessels. Some edema can be expected, such as swollen ankles when you’re pregnant or a traumatic ankle sprain; but edema can be caused by life-threatening conditions, such as heart disease or kidney failure. But how do you know if your puffy face or swollen hands and feet are concerning or something that you can manage at home? Learn more about types of edema, the difference between mild and severe edema, and edema complications.

Edema has many causes, some preventable, some not. For example, if you’ve been standing for a long period, especially in hot weather, you may notice some mild edema in your ankles and feet, sometimes your lower legs as well. This is the result of excess fluid pooling at the lowest point.

If you are healthy or aren’t pregnant, this swelling will likely go away fairly quickly once you start walking around or you sit down and put up your feet. Sitting for prolonged periods, like on an extended car trip or flying in a plane, can also cause swelling in your ankles and feet.

Other possible causes of edema include:

• Pregnancy: As a pregnancy progresses, women retain extra fluid. Swelling most often occurs in the feet and ankles, but it can also be present in the hands and face. Some edema during pregnancy can be considered normal, but any edema should be reported to your doctor or midwife to rule out more serious issues, particularly in the later stages of pregnancy. Severe edema could be caused by deep vein thrombosis (DVT), preeclampsia or cellulitis.

• Menstruation: The hormonal changes that occur during menstruation can cause edema similar to what happens with pregnant women.

• Some medications: Certain medications, such as calcium channel blockers (for high blood pressure), estrogen, steroids, and even some antidepressants can cause edema. Steroids, like prednisone, are known to cause a “moon face,” swelling in your face.

• Chronic venous disease: Your veins have valves to help push your blood back up to your heart as it circulates. With chronic venous disease, the valves don’t function properly, so fluid isn’t able to leave your legs and it pools, causing edema.

• Deep vein thrombosis (DVT): A blood clot, most commonly in your leg, can cause swelling below the clot because blood cannot flow back effectively.

• Heart disease or heart failure: Your heart may not be able to pump effectively, allowing fluid to pool in not only your legs, but also in your lungs. This is called pulmonary edema.

• Kidney disease: Your kidneys work on maintaining a healthy fluid balance in your body. If they malfunction, fluid can accumulate, causing edema, usually in the legs and face, around the eyes.

• Liver disease: If your liver is scarred, these scars could block blood flow, causing edema. People with advanced liver disease or cirrhosis can develop a swollen abdomen, looking like a pregnancy, called ascites. This is caused by edema.

• Problems with the lymphatic system: Your lymphatic system is composed of lymph nodes and vessels. If these are damaged, through illness or surgery, fluid can leak into the body tissue, causing lymphedema. The area the edema appears depends where the damage is to the lymphatic system.

Obesity and a high-salt diet can also contribute to edema, but they don’t usually cause it.

The definition of edema is fluid in your body’s tissues, but there are different terms related to edema, including:

• Peripheral edema: Fluid accumulates in the peripheral vascular system, usually the legs and feet, although it can affect the hands and arms as well.

• Pedal edema: Fluid accumulates in your feet and lower legs.

• Pulmonary edema: Fluid accumulates in your lungs.

• Cerebral edema: Fluid accumulates in your brain.

• Pitting edema: When you press on a swollen area and then release it, the skin should return to its normal presentation. If it doesn’t and the indentation remains for a while after the pressure is released, this is pitting edema.

Complications Related to Edema

Some edema can go away on its own, depending on its cause. But there are several situations where edema could cause serious complications, such as:

• Pain from the stretched skin or the pressure from swelling

• Stiffness, particularly if the edema is near a joint

• Difficulty walking

• Itchy and dry skin over the edematous area

• Sores over the edematous areas

• Infection in the sores

• Decreased blood circulation to the edematous area and below

• Difficulty breathing or shortness of breath (pulmonary edema)

• Chest pain (pulmonary edema)

• Change in behavior or consciousness (cerebral edema)

When to See Your Doctor about Edema

If you are pregnant, speak to your doctor about any edema you notice. While it may be normal, it’s safer to be checked to ensure there isn’t anything serious that may be causing the swelling. Contact your doctor about edema if:

• You have a fever.

• The skin on or around the edematous area is red and warm to touch.

• You have open sores in or around the edematous area.

• You have a history of kidney, heart or liver disease.

If you have chest pain or shortness of breath, or a change in your mental status, this is a medical emergency. Call 911 immediately.

Mild edema can often be treated at home, but it is always best to speak with your doctor, especially if you see any changes, including how much swelling there is, how often it appears, and if there are any other symptoms of health problems that could be contributing to the swelling.

Swollen ankles, feet and legs (oedema)

Swelling in the ankles, feet or legs often goes away on its own. See a GP if it does not get better in a few days.

Common causes of swollen ankles, feet and legs

Swelling in the ankles, feet and legs is often caused by a build-up of fluid in these areas, called oedema.

Oedema is usually caused by:

• standing or sitting in the same position for too long
• eating too much salty food
• being overweight
• being pregnant – read about swollen ankles, feet and fingers in pregnancy
• taking certain medicines – such as some blood pressure medicines, contraceptive pills, antidepressants or steroids

Oedema can also be caused by:

Check if you have oedema

Symptoms of oedema include:

Swollen or puffy ankles, feet or legs.

Credit:

Shiny, stretched or red skin.

Credit:

How to ease swelling yourself

Swelling in your ankles, feet or legs should go away on its own, but there are some things you can try to help.

Do

• lie down and use pillows to raise the swollen area when you can

• get some gentle exercise, like walking, to improve your blood flow

• wear wide, comfortable shoes with a low heel and soft sole

• wash, dry and moisturise your feet to avoid infections

Don’t

• do not stand or sit for long periods of time

• do not wear clothes, socks or shoes that are too tight

Non-urgent advice: See a GP if your ankle, foot or leg is swollen and:

• it has not improved after treating it at home for a few days
• it gets worse

Information:

Coronavirus (COVID-19) update: how to contact a GP

It’s still important to get help from a GP if you need it. To contact your GP surgery:

• visit their website
• use the NHS App
• call them

Find out about using the NHS during COVID-19

Urgent advice: Get advice from 111 now if:

• the swelling is only in 1 ankle, foot or leg and there’s no obvious cause, such as an injury
• the swelling is severe, painful or starts very suddenly
• the swollen area is red or feels hot to the touch
• your temperature is very high, or you feel hot and shivery
• you have diabetes

111 will tell you what to do. They can arrange a phone call from a nurse or doctor if you need one.

Go to 111.nhs.uk or call 111.

Other ways to get help

A GP may be able to treat you.

Ask your GP practice for an urgent appointment.

Treatment for swelling and oedema

Treatment for swelling or oedema that does not go away on its own will depend on the cause.

It may include lifestyle changes, such as losing weight or going on a low-salt diet.

Page last reviewed: 14 November 2018
Next review due: 14 November 2021

Edema, Causes, Risk Factors and Treatment

Edema, (alternate spelling: oedema) formerly referred to as dropsy or hydropsy, is the swelling of the body’s tissues due to excess interstitial fluid retention. Edema can occur locally, often affecting the extremities (peripheral edema), or generally, affecting the entire body (anasarca).

In the body, there are two main compartments between which fluid is exchanged: the intravascular and extravascular compartments. Intravascular compartments include the cardiac chambers and the vascular system itself, whereas the extravascular compartments include everywhere else. Fluid moves easily between these compartments, and the extent of this movement is determined primarily by the balance between hydrostatic and oncotic pressures.

Hydrostatic pressure refers to the pressure exerted by gravity on a fluid at equilibrium, and tends to cause fluid to filter out into the extravascular compartment. Oncotic pressure is a form of osmotic pressure in which proteins in the plasma pull fluid back into the intravascular compartment. Typically these pressures are balanced relatively equally, with a net filtration into the extravascular compartment of about 1% of the plasma. The lymphatic system then transports this extra fluid back into the intravascular compartment through the thoracic duct. Therefore, any change in the balance of these pressures that results in a net filtration greater than the lymphatic system can effectively transport can cause edema.

Symptoms of Edema

In addition to pronounced swelling, typically the overlying skin will have a stretched, shiny appearance. In cases of pitting edema, the skin over the affected area will retain a distinct dimple for 10 to 15 seconds after being depressed. In patients with peripheral edema, the swelling is often worst after extended periods of sitting or standing. Anasarca, or general edema, will present with swelling covering the entire body. Ascites refers specifically to fluid retention in the peritoneal cavity, and results in distinct swelling of the abdomen.

Etiology

An increase in hydrostatic pressure can occur as a result of heart failure, kidney failure, liver failure or venous obstruction. Decreased oncotic pressure occurs in patients with malnutrition resulting in an abnormally low level of blood proteins. In addition, any conditions affecting the permeability of vascular membranes, including inflammation or tissue trauma, can also cause more fluid to “leak” out of the intravascular compartment. When the body notices that this leaking is happening, the kidneys in turn retain more water and sodium to make up for the loss of fluid, causing more blood to circulate and more leakage to occur. Edema related specifically to the impairment of the lymphatic system in carrying away interstitial fluid is referred to as a lymphedema.

Risk Factors

Edema itself is not a disease, but a symptom. Less severe forms of edema can result from lifestyle and general health factors such as:

• Staying in one position (sitting, standing or supine) for too long
• Increased sodium intake
• Hormonal changes due to menstruation
• Pregnancy

Edema can also occur as a side effect of several different medications, including:

• Vasodilators
• Calcium channel blockers
• Estrogen-based medication
• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Certain diabetes medications

However, edema can also be a sign of severe underlying medical conditions, such as:

• Congestive heart failure
• Cirrhosis
• Kidney disease
• Chronic venous insufficiency
• Chronic lung diseases (pulmonary edema only)
• A damaged lymphatic system

Complications

If left unchecked, peripheral and general edema can result in the overlying skin becoming stretched, developing infections or ulcerating. Also, decreased blood circulation can lead to blood clots in the deep veins of the body, also known as deep vein thrombosis.

Diagnostic Studies

• Ultrasound of heart, chest, peritoneum and extremities
• Blood tests and urine analysis to evaluate renal and liver function, as well as albumin levels
• X-rays including MRI, CT scan, lymphangiography

Treatments & Interventions for Edema

Depending on diagnosis, the following precautions may help minimize the risk of developing edema in at-risk patients and to minimize complications in patients already exhibiting symptoms:

• Reduce daily sodium intake.
• Avoid tight clothing and jewelry that could constrict the affected area
• Avoid extreme temperatures.
• Keep the affected limb above your heart when possible.
• Lymphatic massage to the affected area can help move excess fluid. Find a qualified lymphedema therapist to properly perform this procedure.
• During activity, monitor the affected limb for any change in size, shape, tissue, texture, soreness, heaviness, or firmness.
• Pay particular attention to the limb during air travel, as the decrease in pressure and extended time seated can exacerbate existing symptoms of edema. Consider wearing a compression garment for such travel, except if you have open wounds or poor circulation in the affected limb

Treating edema should always begin with diagnosing and treating the underlying cause. Depending on the cause, diuretics may be prescribed to increase water output from the kidneys and combining these with a low-sodium diet can help to decrease fluid retention. Other medications and treatments may be prescribed as well. Peripheral edema can also be treated by wearing prescribed compression stockings or garments, which apply more pressure to the affected area and can help force fluid to be reabsorbed into the intravascular compartment.

References

Cleveland Clinic. Edema. Cleveland Clinic. http://my.clevelandclinic.org/disorders/edema/hic_edema.aspx. Accessed April 25, 2018.
Cunha JP. Edema. MedicineNet.com. MedicineNet, Inc. http://www.medicinenet.com/edema/article.htm. Accessed April 25, 2018.
Klabunde RE. Tissue Edema and General Principles of Transcapillary Fluid Exchange. Cardiovascular Physiology Concepts. https://www.cvphysiology.com/Microcirculation/M010.htm. Updated July 11, 2011. Accessed April 25, 2018.
Mayo Foundation for Medical Education and Research. Edema. Mayo Clinic. http://www.mayoclinic.com/health/edema/DS01035. Published October 11, 2011. Accessed April 25, 2018.
MediLexicon International Ltd. What Is Edema? What Causes Edema? Medical News Today. http://www.medicalnewstoday.com/articles/159111.php. Published July 29, 2009. Accessed April 25, 2018.

Swollen Legs and Ankles with Red Blotches – Blog

Swollen Legs and Ankles: When to Visit the Doctor

If you’ve begun to notice an abnormal amount of swelling in your legs and ankles, you may want to schedule an appointment with your primary care physician. Swollen legs and ankles along with red blotchy skin can occur for a variety of reasons, but several may require examination and treatment.

If you have swollen legs and ankles, especially if you frequently work on your feet all day, it could be a sign of what’s called edema. Edema is a condition in which fluid builds up in certain tissues of the body, most commonly in the hands, arms, ankles, legs and feet in what’s known as peripheral edema. According to the National Institute of Health, signs of edema include:

• Swelling in your lower extremities, feet, ankles, and legs
• Swelling in your upper extremities, hands and arms
• Swelling in your face or abdomen
• Skin that is puffy, shiny, or looks slightly dented after being pressed
• Shortness of breath, a cough, or irregular heartbeat
• Clothing and jewelry feels tightened

Edema itself can be attributable to a variety of causes. Some more serious than others. It’s important to see a doctor and check what is causing it to make sure it gets treated correctly.
Edema can be caused by:

• Temporary water retention issues that should take care of itself
• A symptom of a more serious disease that requires treatment
• An obstruction or blockage in the veins, such as from a tumor or deep vein thrombosis.
• A problem with the valves in the veins.
• A muscle pump failure due to inactivity, neuromuscular disease, aging, arthritis, or sedentary lifestyle, such as being on your feet for long periods of time.
• Adverse effects of medication or an allergic reaction

Make an appointment with your healthcare provider right away if you begin to notice swelling stretched or shiny red skin and pain. Helping your doctor answer questions about your medical and life history can help them make an accurate diagnosis.

Factors that can play a role in affecting your circulation can include diabetes, liver or kidney disease, high blood pressure, obesity, multiple pregnancies, heart disease and more. Even work/living conditions can play a role, whether it be standing or sitting all day. Call 911 immediately if you experience

• Shortness of breath
• Difficulty breathing
• Chest pain

Steps to Prevent Swollen Legs and Ankles

If you do experience symptoms of edema, make an appointment with your primary care physician before attempting any treatment. Your doctor may make the following recommendations:

Get more comfortable

Wearing more loose-fitting clothing and shoes can help ease swelling. Additionally, try to avoid being in the same position all day, in other words, don’t be on your feet all day and don’t sit all day. When laying down, elevate your feet with a pillow.

Light exercise

Your doctor may also recommend light exercise to help improve your leg circulation. This can include walking, stretching or bicycling. However, you may not be advised to walk or stand too much.

Limit salt

Avoiding salty and high-fat foods such as bacon, chips or french fries can help lower your risk of high blood pressure.

Support stockings

Support stockings help to support your veins and muscles in the lower legs, thus assisting with your lower leg circulation. You should put the stockings on first thing in the morning before your legs start to swell.

For more information about swollen legs and ankle treatment, make an appointment with your primary care physician. Call 1 (833) VLLYWSE to make an appointment today.

Sources:
1. https://www.ncbi.nlm.nih.gov/books/NBK279409/

Socks for Edema – The Ultimate Remedy for Swollen Feet (With Pictures!)

Last Updated April 18, 2020

Compression Socks Intervention In the Misery that is Edema

Obviously, leg swelling can be a major buzz kill. Imagine traveling for five hours to work or vacation and having to deal with heavy and sore legs when you reach your destination. Instead of accomplishing the purpose of your work or vacation, you end up dragging yourself around with swollen puffy legs. This swelling is thanks to a condition called edema. Edema occurs when tiny pockets of your body’s tissues have started retaining fluid. Thankfully, you can manage your edema with socks that prevent the accumulation of fluid in your legs and feet.

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Swollen legs can also worsen health conditions such as pregnancy. During pregnancy, you are already handling a lot: a growing belly, increased weight, and the nutritional and emotional wellbeing for two. Then edema waltzes in, now making an already difficult situation overbearing. Regardless of your circumstance, compression socks for edema are essential for people struggling with fluid accumulation in the legs.

What Causes Edema and Why does it Warrant Compression Socks?

Edema is a symptom of an underlying health problem. Some of the conditions known to trigger fluid retention include,

• Eating meals with high sodium content
• Pregnancy
• Certain medications that interfere with fluid homeostases such as NSAIDs and corticosteroids
• High estrogen levels
• Medical Conditions which affect the heart, liver and kidney

Edema develops when fluid leaks from your blood and accumulates in the tiny spaces of your body tissue. Pressure, inflammation or tissue damage can cause this fluid to be released from your blood capillaries and spread into various areas of your body. The leakage could also become localized in a particular area. When the fluid collects specifically in your feet, this turns into peripheral edema.

Normally, the body tries to rectify this problem by retaining more fluid in the kidneys. However, this doesn’t alleviate the issue; it actually worsens the leakage in your legs causing even more swelling. Peripheral edema, thank heavens, can be contained with specialty socks for edema.

Edema Occurs in Other Body Regions too

Aside from the legs, fluid accumulation can happen in any part of your body. Peripheral edema, for instance, also occurs in your hands.  Other susceptible areas include the abdomen and face. Medical socks prevent fluid buildup in your legs by improving circulation.

Your Physician and Socks for Anti-swelling

While the process of fluid accumulation development is known, the cause must be examined by a physician. Socks for edema can provide a much needed solution for swelling and soreness in the legs. Your doctor might prescribe these socks for you once your prognosis is determined and treatment is initiated.

Unfortunately, compression socks alone will not cure the cause of edema but they can serve as a preventative and management solution for edema. They will also help alleviate the discomfort of edema, as well as dissolve the circulation problem that gives rise to fluid leakage.

Edema in Your Lower Limbs

Fluid retention in your legs occurs primarily due to poor blood circulation. Blood circulation from your lower extremities to your heart is exceptionally difficult compared to blood circulation to the rest of your body because of several reasons.

Blood Flow Rate in the Veins

There are two main blood vessels involved in blood transportation: the veins and the arteries. Blood in your veins flows at a lower rate compared to blood in your arteries. The energy of the flow rate in the arteries is created by your pumping heart. Arteries are the first to receive blood from the heart and transport it to the rest of the body.

Why Blood Flow Slows Down in Your Veins

The rate of blood flow reduces as blood is exchanged between the arteries and veins through the capillaries. Therefore, as the veins take the blood back to the heart the flow rate is tremendously reduced. This slower rate increases the likelihood of blood stagnation in the veins, especially in tissues located further from the heart.

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The proximity of Your Lower Limbs to the Heart

The further your tissues are from the heart the slower blood flows in your veins. Blood seems to stagnate in your lower limbs creating the possibility of fluid leakage into the surrounding tissues. The condition is aggravated when you are inactive for long periods of time.

Gravity also affects circulation because it acts against the direction of blood flow in your legs. Consequently, blood in the veins tends to linger in your lower limbs increasing the chances of fluid leakage, particularly, when you are inactive. While the effects of gravity can be countered with physical activity, medical conditions, lifestyle and medication may limit your ability to remain active. Therefore, you need an alternative to combat gravity in long periods of rest. The good news is compression socks can prevent fluid accumulation in your legs by countering the force of gravity.

The Importance of Leg Activity

Unless you are inactive for long periods of time, blood flow in your veins should not be a cause of concern. In addition to using compression socks, incidences of stagnation can be thwarted by becoming more active. Walking and exercising, for instance, improve circulation in your lower limbs through the contraction of your calf muscles. The muscles squeeze your veins creating enough force to push up the blood.

How Edema Socks Function

The purpose of compression socks is to improve circulation in your legs; this, in turn, prevents pulling and retention of blood and fluids. The socks are a part of compression attire which function by adding pressure in your veins causing blood to flow continuously. By managing circulation, these socks prevent the development of edema.

Compression Ratio

Socks for preventing fluid accumulation have specific features that enable it to improve blood circulation. Each feature contributes to making your blood flow in a unique way. One such feature is the compression ratio. The compression ratio determines the degree of pressure subjected to your leg veins. Socks for edema have fixed compression ratios.  The ratios indicate the maximum and minimum pressure contained in the socks. Compression is measured in mmHg (read as millimeters of mercury) because it is a measure of pressure. The socks come in three standard compression ratios: 15-20mmHg, 20-30mmHg and 30-40mmHg.

Each standard ratio solves blood circulation problems in varying degrees.

• The 15-20mmHg compression socks, for instance, are perfect for minor and occasional swelling. Your doctor may recommend this compression ratio if your condition is mild.
• The 20-30mmHg socks, on the other hand, are the first medical grade socks. They can be used to manage leg swelling during pregnancy. They also provide relief for heavy and fatigued legs.
• The 30-40mmHg socks belong to the second medical grade. They are a perfect solution for severe edema.

If you are unsure of which compression ratio is suitable for your condition, seek medical advice from your physician.

Graduated Compression Factor

Anti-swelling socks also have varying pressures along their length; this pressure difference is known as the graduated compression factor. For example, a 20-30mmHg sock has its highest pressure at 30mmHg at the bottom of the hosiery and the minimum pressure, 20mmHg, at the top.  

The pressure variation is quintessential in creating the needed pressure to maintain blood flow in your leg veins.The pressure decreases gradually from the bottom to the top of the socks creating the needed force that steers the flow of blood from your legs to your heart. The graduated compression factor is an important facet of any compression gear. Without it, the socks are useless.

The Length of Anti-Edema Sock

Compression socks come in different lengths. The length of the socks determines its area of action. Knee-high socks work on the feet, ankles and calf. Thigh-high socks, on the other hand, work on the lower leg and the thighs. Full-length hosiery work on the entire leg length, as well as the pelvic region. The type of length you choose is dependent on your condition and the location of the edema. If your fluid accumulation is localized in your lower legs, then having knee-high socks will be sufficient to eradicate fluid accumulation in that region.

Quality of the Socks

Socks for preventing leg swelling may have the necessary graduated compression but lack in other important characteristics. If the sock does not fit your leg, it will not be effective in improving blood circulation.  Therefore, the material used to make the socks should have long-lasting elasticity and the tensile strength to grip your leg muscles for long periods time. The sock material can also predict the quality, usability and durability of the socks.

When considering the size of the socks, ensure that the socks fit both vertically and along the length of your leg. Your compression socks must properly fit your legs, otherwise they will be inefficient in improving circulation. The sock will only prevent fluid percolation and retention in your leg tissues if it possesses all these characteristics.

Compliance

It is essential that you adhere to wearing the socks according to your doctor’s instructions. Removing the socks before the stipulated time will not reduce edema. Similarly, the socks should not be rolled down. They should be always pulled up on your legs.

The duration of donning compression socks will depend on your medical condition. Your doctor will advise on the number of days you will be wearing the socks. Typically, the socks are worn from the time you get out of bed until you go to bed at night, for a specified number of days. Your doctor will also examine your condition during this period of time to determine whether the socks are effective in reducing edema.

Severe cases may require switching to socks with high compression ratios. Most importantly, you must be willing to comply to get better.

Studies have shown that compression gear will not work properly if the patient does not comply fully with the requirements. Removing the socks before the day ends and folding them interferes with their mechanism of action.

Anti-Edema Socks are the Cat’s Pajamas

Socks for edema are fundamental in eliminating swelling, leg heaviness and soreness. Compression socks come in handy during sickness enabling you to pull through without the discomfort and dangers of poor leg circulation. You can now enjoy long trips or occupations that require long standing and/or sitting periods.

Now that you know the many benefits of these medical socks, you are at an advantage when making informed decisions concerning which socks to purchase and how to use the socks for the best results.

Remember, compliance is key to a good outcome!

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What is Peripheral Edema? (with pictures)

Peripheral edema refers to swelling in the body’s extremities. Most commonly it affects the legs and feet. The direct cause of edema is the accumulation of fluid within the tissue of the affected body parts. There are many underlying causes that can produce this outcome.

One of the most common causes of peripheral edema is old age. Aging is also associated with a number of more specific causes. These include varicose veins and other problems with circulation in the legs. Rheumatoid arthritis can cause edema via inflammation. Sitting or standing without moving for a long period of time can be enough to cause this condition.

Other potential causes include burns, bites or stings, clots, infections, and lymphatic obstructions. Swelling can result from any modification to the pressure of fluid or tissue in the legs, including inflammation, blood vessel pressure, lymphatic pressure, and other changes. All of these factors combine with the effect of gravity, which explains why the legs and feet are the most common targets of edema.

The hormones associated with pregnancy and menstruation, also found in various medications, can induce the condition in some women. There are other drugs that can cause the condition as well, in particular blood pressure medication and steroids. Some kinds of antidepressants can cause peripheral edema. These include monoamine oxidase inhibitors and tricyclics, but not selective serotonin reuptake inhibitors.

Peripheral edema is a common side effect of other more serious medical conditions. Emphysema reduces the ability of the body to acquire oxygen through the lungs, and swelling of the legs and feet can result. Problems with the liver, heart, kidney, and bladder can have similar effects. Altitude sickness, which results from extreme changes in pressure, can cause peripheral and other forms of edema. If a person develops this condition that has no obvious cause and does not go away after moving around, he or she should probably seek medical attention.

There are a few ways to reduce the swelling caused by transient, or temporary, peripheral edema. Raising the legs to drain some of the fluid is a good idea unless the edema resulted from a poisonous bite. Also, try to consume less salt and move the legs. Because this condition has so many different causes, effective treatment will depend largely on diagnosing its particular source. Persistent, or recurring, edema can independently cause neuropathic damage.

Peripheral edema with pregabalin | CMAJ

A 76-year-old woman with a 20-year history of chronic pain in her back and legs caused by degenerative spondylolisthesis, spinal stenosis, morbid obesity, venous insufficiency and osteoarthritis presented to our chronic pain clinic. She had previously undergone a laminectomy at L4–L5/L5–S1 and, 2 years later, an L1–S1 decompression and fusion.

In 2008, after the decompression surgery, the patient was given pregabalin (titrated to 300 mg, twice daily) for ongoing neuropathic pain. Increasing peripheral edema in the patient’s legs was documented from that time on. In 2011, chronic wounds with serous drainage developed on the patient’s legs. In early 2012, the patient spent 53 days in hospital with a diagnosis of cellulitis, and she was no longer independently mobile. Investigations ruled out deep venous thrombosis, liver dysfunction and malnutrition.

The patient was admitted to hospital because of poor pain control, chronically weeping leg wounds and poor mobility. The edema was more severe in her right leg, with the calf measuring 57 cm in circumference (Figure 1). We decreased the patient’s pregabalin dose and stopped its use within 1 week of admission. By the 10th day of the patient’s stay, the circumference of each calf had decreased by 10 cm, and the wounds on her right leg were healing and no longer weeping (Appendix 1, available at www.cmaj.ca/lookup/suppl/doi:10.1503/cmaj.121232/-/DC1).

Figure 1:

Peripheral edema in a 76-year-old woman taking pregabalin for neuropathic pain.

Pregabalin is used to treat neuropathic pain. The drug’s likely mechanism of action is binding to the α₂δ subunits of voltage-gated calcium channels in presynaptic neurons, thereby reducing the release of the excitatory neurotransmitter glutamate.

In older adults, common adverse effects of pregabalin include dizziness (34%) and drowsiness (22%).1 Peripheral edema (15%)1 and worsening of heart failure symptoms have also been reported.2^,3 These effects may be the result of antagonism of the L-type calcium channel in the vasculature causing vasodilatation, similar to the mechanism of action of calcium channel blockers used to treat hypertension.

Peripheral edema may go unrecognized as an adverse effect of pregabalin, leading to loss of mobility and a prolonged stay in hospital as in the case of our patient.

Footnotes

• Competing interests: Romayne Gallagher has received honoraria from Purdue Pharma. No other competing interests were declared.

• This article has been peer reviewed.

90,000 types and causes of edema, how to get rid of edema

The main factors contributing to the development of edema – changes in the biochemical composition of blood plasma and tissue fluid, hormonal changes, increased capillary permeability, obstruction of the outflow of venous blood and lymph, impaired gas exchange and renal excretory function, congestion in heart failure, sedentary lifestyle and critical ischemia, when a person is forced to sleep with a lowered leg due to pain.

True edema can be local and general. With general edema, fluid accumulates throughout the body, with local it lingers on the diseased part of the body. Each of these two species has many varieties. Let’s consider the main ones.

General edema

Pulmonary heart failure. Under the influence of gravity, edematous fluid accumulates in the lowest part of the body. In bedridden patients, these are the areas of the sacrum and lower back. Concomitant symptoms are shortness of breath, swelling of the cervical veins, congestive liver, ascites, hydrothorax, and other signs of pulmonary heart disease.

Kidney disease

With glomerulonephritis, pyelonephritis and other kidney diseases, edema is formed first on the face (on the eyelids), and then on the limbs and trunk. With the development of nephrotic syndrome, edema can gradually spread to the entire body, including serous cavities (in this case, they speak of edema syndrome).

Cirrhosis of the liver

In addition to edema, there are other signs of liver cirrhosis – ascites, enlargement of the veins of the esophagus (as determined by EGD), bleeding from the esophagus, enlargement of hemorrhoidal veins, liver failure.

Depletion

Edema of a similar origin occurs during starvation, alcoholism and some diseases of the gastrointestinal tract, accompanied by an accelerated excretion of proteins from the body. The legs and feet swell, the face becomes puffy (protein-free edema).

Local edema

Varicose veins of the lower extremities. Edema (more often the lower third of the leg, bilateral, but sometimes asymmetrical, more pronounced on the diseased side) occurs in people who have been suffering from varicose veins for a long time.It appears after a long standing on the legs and passes in the “lying” position with raised legs. Varicose veins are clearly visible, which helps to make a diagnosis.

Deep thrombosis and thrombophlebitis of saphenous veins

Swelling of the extremity due to clogged veins with blood clots occurs after childbirth, surgery on the abdominal organs, with tumors, leukemia and some other diseases. In acute thrombosis and thrombophlebitis, edema is often one-sided, appears suddenly, grows and subsequently becomes permanent.The characteristic symptoms of pain are revealed. With thrombophlebitis, there is a local compaction and hyperemia of the limb along the affected vein.

Post-thrombophlebitic syndrome

First appearing with vein thrombosis, edema is constantly present. It is more often one-sided, can cover the lower leg and thigh. After a few years, varicose veins of the affected limb, characteristic pigmentation, thickening of the subcutaneous fatty tissue and trophic skin disorders (venous dermatitis and eczema, trophic ulcers) may join.

Lymphedema

Swelling of the feet and legs, in the last stages of the disease, the thigh may also swell. The defeat is often one-sided. Edema at the initial stage of the disease is temporary, then becomes permanent. In advanced cases, the edema becomes very dense, fibrous growths appear on the skin of the feet and legs. The triggering factor can be repeated erysipelas, oncological diseases of the intestines and pelvic organs, bacterial and parasitic lesions of the lymph nodes of the groin region.

The combination of lymphedema with varicose veins is called phlebolymphedema. Edema is more often bilateral, there may be trophic ulcers on the skin.

Diseases of the joints

With diseases of the joints and flat feet, the area close to the affected area swells.

Brain diseases

With a brain tumor, encephalitis and other diseases of the central nervous system, accompanied by paralysis of the limb, there may be edema on the side of paralysis due to impaired muscle contractility and paresis of peripheral vessels (their persistent expansion).

Injury

In case of trauma, small blood vessels rupture, a hematoma occurs. The affected area is swollen. Cerebral edema is especially dangerous in traumatic brain injury.

Idiopathic orthostatic edema

When translated into “ordinary” language, the term means that the cause of this type of edema is not established and it appears when a person is in an upright position. Mostly young women suffer, temporary edema occurs in the lower part of the legs.

Edema with obliterating atherosclerosis

Edema develops as a result of an increase in the patient’s pain syndrome when his legs are in the “lying” position. Critical ischemia develops. The patient is forced to lower the affected limb (s) from the bed to relieve pain, since at this stage of atherosclerosis, pain relievers no longer help. The only way to sleep without pain is a forced position with your legs off the bed. As a result of this, a stagnant process develops in the limb and edema occurs.

Diagnostics and treatment

One of the main areas of work of our department is the diagnosis and treatment of diseases manifested by edema. To confirm the diagnosis, all the necessary measures are taken, including laboratory and instrumental diagnostics.

It is not easy to recognize the cause of the edema: there are many known of them, but only one needs to be established. The doctors of our department can do it: they are experts in this field.

The complex of treatment measures carried out for each patient is individual, but it is always aimed at solving two main problems.On the one hand, it is necessary to stop the edema, on the other hand, it is necessary to ensure normal blood circulation in the tissues and lymph drainage from the edematous zone.

To achieve the desired result, the specialists of the department use, depending on the cause of the edema, various procedures – infusion therapy (droppers with drugs prescribed in accordance with the nature of the pathological process), ILBI (intravenous laser blood irradiation), magnetotherapy, variable pneumocompression (hardware lymphatic drainage) , electromyostimulation, ozone therapy and others.

Specialists of the Department of Phlebology are proficient in modern effective therapeutic and surgical methods for treating pathology leading to edema.

If you are worried about edema – come to our doctors for an appointment!

Clinics Chaika – Chaika.com

Edema is the accumulation of fluid in tissues and organs. Edema can appear anywhere on the body, but is most common in the legs, arms (peripheral edema), in the abdomen (ascites), and in the chest (pulmonary edema, pleural effusion).

Ascites and peripheral edema can be uncomfortable and a sign of serious illness. Pulmonary edema can be life-threatening.

Edema looks like swelling, puffiness, stretching the skin and giving it a shine. It tends to increase in the lower body due to gravity – for example, swelling in the lower legs may be most noticeable after long walking, standing or sitting, or at the end of the day. Swelling can occur in the lower back when lying down for a long time.Briefly pressing the swelling area with your finger leaves a dimple in the skin. In the case of ascites, the edema is manifested by an increase in the circumference of the abdomen, in the case of edema in the chest – difficulty in breathing.

Causes

• Chronic venous diseases. With the defeat of the valves of the veins of the lower extremities, the blood stagnates in the lumen of the vessels. This can lead to stagnation of fluid in the lower leg area, thinning of the skin and, in some cases, to the appearance of ulcers on it. Also, edema can develop as a result of blood clots in the deep veins of the legs.In such cases, the swelling is usually limited to the foot and ankles and is unilateral — swelling associated with other conditions usually affects both legs.
• Pregnancy. During pregnancy, fluid is retained in the body. Towards the end of a normal pregnancy, swelling often develops in the area of ​​the hands, feet, and face. In the absence of other symptoms and deviations, such swelling is not a sign of pathology.
• Menstruation. Regular monthly swelling in women can occur as a result of natural hormonal changes during the menstrual cycle.They do not require treatment, they disappear on their own.
• Medicines. Swelling can result from side effects of many medications, including estrogen-containing and over-the-counter pain relievers (such as ibuprofen), diabetes medications, and hypertension.
• Kidney disease. With kidney disease, swelling usually occurs in the shins and on the face, around the eyes.
• Heart failure. It develops in diseases that impair the pumping function of the heart.In addition to other symptoms, heart failure can be manifested by edema of the legs and abdomen. Also, with heart failure, pulmonary edema is possible, accompanied by difficulty breathing. This condition can be very dangerous and requires urgent treatment.
• Cirrhosis of the liver. Cirrhosis – the process of replacing liver tissue with scar tissue – can prevent blood from flowing through the liver. People with cirrhosis may experience a pronounced enlargement of the abdomen due to edema, swelling of the legs.
• Travel. Swelling of the legs can occur after long periods of sitting, such as when flying. This is a common occurrence and is usually not a symptom of an illness. But edema that persists for several days or the appearance of pain in the legs several hours / days after the flight requires a doctor’s examination. Swelling and pain in this case can be a sign of venous thrombosis.
• Angioneurotic edema. With the use of certain drugs and with some hereditary diseases, fluid may escape from the vascular bed into the surrounding tissues.This condition can manifest itself in rapidly progressive swelling of the face, lips, tongue, mouth, pharynx, glottis, extremities, and genitals. Manifestations may include a hoarse voice, a feeling of tightness in the throat, and difficulty swallowing. A swollen throat can be life-threatening. In some cases, this type of edema can occur in the intestinal wall and manifest as abdominal pain.
• Lymphedema. Surgical removal of lymph nodes in the treatment of cancer (mainly in breast cancer) can cause swelling of one or both limbs with thickening of the skin on the side of the intervention.There is also a hereditary pathology with the involvement of the lymphatic system, which usually debuts in childhood or adolescence and is manifested by swelling of both lower extremities.

When to see a doctor

If you first find swelling in one or both arms, legs, abdomen or around the eyes, you should contact your doctor and decide on the examination. Edema can be a “harmless” finding, but it can also be a symptom of a serious illness. This can only be determined precisely together with the attending doctor.

In the event of a sudden appearance of swelling of the lips, tongue, mouth, especially in case of difficulty speaking or breathing, you should immediately seek help.

Treatment

Not all edema requires treatment. Swelling associated with pregnancy or the menstrual cycle usually does not need to be treated. Peripheral edema and ascites are usually treated slowly to reduce the side effects of rapid fluid loss.

• Reducing salt in food. The sodium in table salt can make swelling worse.Reducing the amount of salt consumed can help reduce swelling, especially when diuretics are used concomitantly.
• Diuretics. Medications that increase the excretion of fluid and sodium by the kidneys can help reduce swelling. Diuretics should be used with caution, as too rapid excretion of a large amount of fluid can provoke a decrease in blood pressure, dizziness, fainting, and also disrupt kidney function. When taking diuretics, patients have to empty the bladder a little more often, but side effects are rare when the recommended dosage is observed.
• Compression stockings. They are used to prevent and treat edema of the lower extremities. Stockings can be knee-high, hip-hugging, or pantyhose-shaped. For most patients, knee height is sufficient. Some stockings can cause skin irritation or pain, although careful sizing can reduce the risk of discomfort.
• Low compression stockings can be purchased at a pharmacy or orthopedic salon without a doctor’s prescription. The selection of compression stockings by a doctor is necessary in case of severe edema, in case of ulcers on the skin, as well as for people who spend a long time on their legs.The doctor can take the necessary measurements to select the stockings or send them to a specialized store.
• White anti-embolic stockings used in surgical hospitals do not put enough pressure on the ankle and are not suitable for treating edema.
• Treatment by position. With edema of the lower extremities, you can use raising the legs above the level of the heart for 30 minutes 3-4 times a day. Elevated leg positioning may be effective for moderate vein disease, but more severe cases require different measures.In addition, this method may not be suitable for working people.

Edematous syndrome

Edematous syndrome

excessive accumulation of fluid in the tissues of the body and serous cavities, accompanied by an increase in the volume of tissues or a decrease in the serous cavity with a change in physical properties (turgor, elasticity) and function of tissues and organs.

The differentiation of edema associated with systemic pathological conditions from those based on local disorders can vary in complexity from a simple and clear clinical task to a very difficult and complex diagnostic problem.Edema can be the result of increased capillary permeability, obstruction of the outflow of venous blood or lymph; fluid can accumulate in tissues as a result of a decrease in oncotic pressure in blood plasma.

What Causes Edema Syndrome

Edematous syndrome is an important symptom of many diseases of organs and the regulatory system and, by its appearance, often serves for the differential diagnosis of diseases that caused edematous syndrome. Distinguish between local (local) edematous syndrome associated with an imbalance of fluid in a limited area of ​​the body or organ, and general edematous syndrome, as a manifestation of a positive fluid balance throughout the body.According to the disease that caused the development of edema, they are distinguished: cardiac, renal, portal (ascites), lymphostatic, angioedema, etc.

As a separate form, pulmonary edema, edema and swelling of the brain, laryngeal edema, hydrothorax, hydropericardium, etc., are distinguished, which are life-threatening or due to complications, since edema is easily infected.

The predominant localization and nature of edema have features in various diseases, which is used for their differential diagnosis.

• Heart disease
• Kidney disease
• Liver disease
• Hypoproteinemia
• Venous edema
• Lymphatic edema
• Traumatic
• Endocrine
  • Myxedema.
  • Fatty edematous syndrome.
• Neurogenic edematous syndrome
  • Idiopathic edematous syndrome (Parkhon’s disease).
  • Hypothalamic edematous syndrome.
  • Trofadema Mezha.
  • Complex regional pains (reflex sympathetic dystrophy).
• Iatrogenic (medicinal)
  • Hormones (corgacosteroids, female sex hormones).
  • Antihypertensive drugs (rauwolfia alkaloid, apressin, methyldopa, beta-blockers, clonidine, calcium channel blockers).
  • Anti-inflammatory drugs (butadion, naproxen, ibuprofen, indomethacin).
  • Other drugs (MAO inhibitors, midantan).

Edema syndrome in cardiac diseases

With cardiac edema , there is usually a history of heart disease or cardiac symptoms: shortness of breath, orthopnea, palpitations, chest pain. Edema in heart failure develops gradually, usually after shortness of breath preceding them. Simultaneous swelling of the cervical veins and congestive enlargement of the liver are signs of right ventricular failure.Cardiac edema is localized symmetrically, mainly on the ankles and legs in walking patients and in the tissues of the lumbar and sacral regions – in bedridden patients. In severe cases, ascites and hydrothorax are observed. Nocturia is common.

Edematous syndrome in kidney disease

This type of edema is characterized by the gradual (nephrosis) or rapid (glomerulonephritis) development of edema, often against the background of chronic glomerulonephritis, diabetes, amyloidosis, lupus erythematosus, nephropathy of pregnancy, syphilis, renal vein thrombosis, and some poisoning.Edema is localized not only on the face, especially in the eyelids (swelling of the face is more pronounced in the morning), but also on the legs, lower back, genitals, and the anterior abdominal wall. Ascites often develops. Shortness of breath, as a rule, does not occur. In acute glomerulonephritis, an increase in blood pressure is characteristic and pulmonary edema may develop. Changes in urine tests are observed. With long-standing kidney disease, hemorrhages or exudates in the fundus may occur. With tomography, ultrasound, a change in the size of the kidneys is detected.Study of renal function shown

Edematous syndrome in liver diseases

Liver diseases lead to edema, usually in the late stage of postnecrotic and portal cirrhosis. They are manifested mainly by ascites, which is often more pronounced in comparison with edema on the legs. The examination reveals clinical and laboratory signs of the underlying disease. Most often, there is prior alcoholism, hepatitis or jaundice, as well as symptoms of chronic liver failure: arterial spider hemangiomas (“stars”), hepatic palms (erythema), gynecomastia and developed venous collaterals on the anterior abdominal wall.Ascites and splenomegaly are considered characteristic features.

Hypoproteinemia

Edema associated with insufficient nutrition develops with general starvation (cachectic edema) or with a sharp lack of protein in food, as well as in diseases accompanied by loss of protein through the intestines, severe vitamin deficiencies (beriberi) and in alcoholics. Other symptoms of nutritional deficiency are usually present: cheilosis, red tongue, weight loss. With edema caused by intestinal diseases, a history of pain in the intestines or profuse diarrhea is often present.Edema is usually small, localized mainly on the legs and feet, puffiness of the face is often found.

How does edematous syndrome manifest

Clinically, the general edematous syndrome becomes visible with a retention of more than 2-4 liters of water in the body, local edema syndrome is detected with less fluid accumulation. Peripheral edematous syndrome is accompanied by an increase in the volume of a limb or part of the body, swelling of the skin and subcutaneous tissue, and a decrease in their elasticity.On palpation, a pasty consistency of the skin is determined, when pressed with a finger, a fossa remains, which quickly disappears, which distinguishes them from false edema, for example, with myxedema it is pressed with difficulty, the fossa is held from several minutes to several hours, and with scleroderma, local obesity, a fossa is not formed at all. The skin is pale or cyanotic, it can crack with an outflow through the cracks of the swollen serous fluid or lymph during the formation of ulcers, against the background of myxedema.

Venous edematous syndrome

Depending on the cause, venous edema can be either acute or chronic.Pain and tenderness on palpation over the affected vein are typical for acute deep vein thrombosis. With thrombosis of larger veins, an increase in the superficial venous pattern is also usually observed. If chronic venous insufficiency is caused by varicose veins or deep vein failure (postphlebitic), then symptoms of chronic venous stasis are added to orthostatic edema: congestive pigmentation and trophic ulcers.

Lymphatic edematous syndrome

This type of edema refers to local edema; they are usually painful, prone to progression, and are accompanied by symptoms of chronic venous congestion.On palpation, the area of ​​edema is dense, the skin is thickened (“pigskin” or orange peel “), when the limb is raised, the swelling decreases more slowly than with venous edema. There are idiopathic and inflammatory forms of edema (the most common cause of the latter is dermatophytosis), as well as obstructive (as a result of surgery, scarring with radiation damage or with a neoplastic process in the lymph nodes), leading to lymphostasis. Prolonged lymphatic edema leads to the accumulation of protein in the tissues, followed by the proliferation of collagen fibers and deformation of the organ – elephantiasis.

Traumatic edematous syndrome

Puffiness after mechanical trauma is also referred to as local edema; they are accompanied by pain and soreness on palpation and are observed in the area of ​​the transplanted injury (bruise, fracture, etc.)

Endocrine edematous syndrome

• Insufficiency of the thyroid gland (hypothyroidism), among other symptoms, is manifested by myxedema – generalized swelling of the skin. The skin is pale, sometimes with a yellowish tinge, dry, flaky, dense.Mucous edema of the subcutaneous tissue is expressed, especially on the face, shoulders and legs. When pressed, the pits do not remain on the skin (pseudo-edema). There are concomitant symptoms of hypothyroidism (decreased all types of metabolism, bradycardia, depression, decreased attention, hypersomnia, deaf voice, etc.) and decreased levels of thyroid hormones in the blood.
• Fatty edema. This type of edema occurs in women and is manifested by noticeable symmetrical obesity of the legs. A common complaint made to the physician is “swelling of the legs”, which actually occurs and is worse in the tilt position.They usually worsen before the onset of menstruation, when bathing in warm water, with prolonged sitting or uncontrolled use of salt. The area of ​​edema is soft, with pressure, a depression appears, there are no symptoms of chronic venous stasis; the long-term existence of these edemas makes it possible to exclude deep vein thrombosis. In a patient with fatty edema, the feet and toes do not change, while in other types of edema of the lower extremities, they swell. Diagnostic difficulties arise with concomitant varicose veins, but the symmetry of the lesion and the typical arrangement of fatty deposits, as well as the normal shape of the feet and fingers, should help in establishing the correct diagnosis.

Neurogenic edematous syndrome

• Idiopathic edema syndrome (Parkhon’s disease) is a clinical symptom observed mainly in women aged 30-60 years and characterized by a decrease in the amount of urine, lack of thirst and the occurrence of edema not associated with pathology of the heart, liver and kidneys. Sometimes there are symptoms of organic cerebral and mild hypothalamic failure: a tendency to obesity, emotional (demonstrative) and vegetative-vascular disorders, residual neurological microsymptoms.Mental trauma is often a provoking factor. The swelling increases with prolonged standing. In addition to edema of the lower extremities, patients may notice an increase in the abdomen and mammary glands. Patients often complain of swelling of the face and hands in the morning, which decreases with movement. The study of the hormonal profile can detect an increased content of aldosterone, an imbalance of sex hormones, a change in renin activity.
• Hypothalamic edema can develop when the hypothalamus is involved (not necessarily directly and directly) in a particular pathological process (heart attack, tumor, hemorrhage, meningitis, trauma) and cause a symptom of inappropriate antidiuretic hormone secretion (usually transient) with hyponatremia and water retention in the body …

Symptoms of water intoxication with fluid retention are also characteristic of Schwartz-Barter disease, caused by an increased release of an ADH-like substance in bronchogenic carcinomas and other non-endocrine tumors. The content of ADH in the posterior lobe of the pituitary gland is normal.

• Trofadema Mezha (Mezha edema) is a very rare disease of unknown etiology, manifested by limited skin edema, which rapidly grows and lasts from several hours to several days, then regresses, but does not completely disappear, leaving residual swelling.In the future, relapses of edema are observed in the same place. The edema is dense; finger pressure does not leave a depression. Skin tightening after relapses becomes more and more pronounced. The edema is gradually organized. The affected part of the skin loses its normal normal shape. Optional symptoms: fever during edema, chills, headache, confusion.

Simultaneously with edema on the face or limbs, edema of the lungs or larynx, tongue can sometimes be noted.Also described are edema of the gastrointestinal tract, labyrinth, optic nerve. This edema is also part of the Melkerson-Rosenthal symptoms.

• Complex regional pain (reflex sympathetic dystrophy) at a certain stage of its development may be accompanied by edema of the painful part of the limb. The main complaint of the patient is a burning vegetative pain. Trauma and prolonged immobilization are among the main risk factors for the development of edema syndrome. Allodynia and trophic disorders (including in bone tissue) are characteristic.

Iatrogenic edematous syndrome

Among the drugs that can lead to edema, hormones (corticosteroids and female sex hormones), antihypertensive drugs (rauwolfia alkaloids, apressin, methyldopa, beta-blockers, clofelline, calcium channel blockers), anti-inflammatory drugs (butadione, naprofen, ibex. , indomethacin), MAO inhibitors, midantan (the latter sometimes leads to pleural effusion).

Cardiac edematous syndrome

They develop with left ventricular failure gradually, after previous shortness of breath, are located on the ankles and legs, symmetrical, in bedridden patients and on the back. The skin is quite elastic, pale or cyanotic, the edema is easily squeezed, but with prolonged edema, the skin can become rough. With right ventricular failure, which is determined by the simultaneous enlargement of the liver and swelling of the cervical veins, simultaneously with edema in the legs, ascites, hydrothorax (usually on the right), rarely hydropericardium can form.There may be pulmonary edema with preceding dyspnea.

Nephritic edematous syndrome

It develops in the earliest stages of acute glomerulonephritis. Edema is localized mainly on the face, upper and lower extremities. The skin is pale, dense, of normal temperature. Rarely develops hydrothorax, hydropericardium, there may be pulmonary edema, but without prior shortness of breath.

Nephrotic edematous syndrome

It develops in subacute chronic glomerulonephritis, renal amyloidosis, nephropathy of pregnant women, some poisoning, especially alcohol, lupus erythematosus, syphilis, renal vein thrombosis.

Swelling mainly on the face, more in the eyelids and under the eyes, increases in the morning, in addition, it can be on the legs, genitals, lower back, anterior abdominal wall. The skin is dry, soft, pale, sometimes shiny. The edema is loose, easily squeezed and displaced when the position of the body changes. Ascites often occurs, there may be hydrothorax, but they are small in volume, and not expressed, there is no shortness of breath.

Cachexual edematous syndrome

It develops with prolonged fasting or insufficient intake of protein in the body, as well as with diseases accompanied by a large loss of protein (gastroenteritis, ulcerative colitis, intestinal fistulas, alcoholism, etc.).

The edema syndrome is usually small, localized on the feet and legs, there is a characteristic puffiness on the face, although the patients themselves are emaciated. The skin has a doughy consistency, dry.

Edematous syndrome of pregnant women

As a manifestation of toxicosis, they occur after the 25-30th week of pregnancy, at an earlier date they are a manifestation of heart failure or develop due to an exacerbation of renal pathology. Initially, the edema is localized on the legs, then expands to the genitals, the anterior abdominal wall, lower back, face.The skin is soft and moist. The edema is easily squeezed through. Ascites and hydrothorax are very rare.

Idiopathic edematous syndrome

They develop in women prone to obesity, autonomic disorders; in the initial period of menopause. At the same time, there are no other systemic diseases and metabolic disorders. Swelling occurs in the morning, on the face, more under the eyes in the form of swollen bags, on the fingers. The swelling is soft and quickly disappears after the usual light massage.

In hot weather, with orthostatic insufficiency (prolonged standing, sitting), edema syndrome can manifest itself in the form of edema on the legs, the skin is often cyanotic, its elasticity is preserved, often hyperesthesia.

A peculiarity is Quincke’s edema, allergic and non-allergic edema syndrome, when it is a hereditary disease.

It is characterized by the sudden development of general or local edema of the subcutaneous tissue and mucous membranes of the larynx; brain and spinal cord, abdominal organs. The edema syndrome develops very quickly, the patient feels distension, but itching is not typical. Laryngeal edema can cause asphyxiation.

Considering that edematous syndrome is a manifestation of insufficiency of some main organ or system involved in homeostasis, when general edema is detected, the patient should be referred or consulted by a specialist of the appropriate profile.Another thing is localized edema, which for the most part is a manifestation of surgical pathology, trauma. Doctors consider these questions in each specific case by nosology or in combination with other diseases.

A special place is occupied by edematous syndrome with gas gangrene. Its peculiarity is a large volume (2-4 liters of fluid per day go into the effusion), rapid growth and spread in the proximal direction, leading to compression of the venous and arterial trunks.This rapidly progressive edematous syndrome is pathognomonic for anaerobic Clostridial infection. It is detected by taking a thread tied around a segment of the limb, it cuts into the skin after 20-30 minutes. This technique was described by ancient doctors, but it has no author’s name. By itself, the reception is unreliable, since the same edema can be caused by other types of infection, especially when the inflammation proceeds in the form of phlegmon, trauma, especially if the vessels are damaged. A distinctive feature is the specific type of skin of the edematous limb in the form of landcard-like spots of an unusual color: bronze, blue, greenish.Non-clostridial anaerobic edema does not give such a specific picture. But in both cases, patients must be urgently hospitalized or transferred to specialized departments of purulent-septic resuscitation, which have the ability to conduct hyperbaric oxygenation with high oxygen pressure (2-3 excess atmospheres – pressure chambers of the “Yenisei” type).

How to recognize edematous syndrome

Serum protein electrophoresis, liver function tests, determination of T4 and TZ content in blood serum, radioimmunoassay of TSH content in blood serum, ECG, chest x-ray, echocardiography, chest CT, radioisotope angiography of the heart, Doppler ultrasound of veins, phlebography, tomography of the kidneys, CT of the abdominal organs, lymphangiography, consultation of a therapist, endocrinologist.

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90,000 What is dropsy and where does it come from?

Dropsy occurs due to the accumulation of excessive amounts of fluid in the tissues of the body. In simpler terms, it is tissue edema. From this material, you will learn what is causing this violation and when you need to sound the alarm.

When fluid leaking from damaged cells is collected in the space between tissues and organs, edema appears.It can affect any part of the body, but most often it appears:

• In the lower legs (including feet) or hands – peripheral dropsy.
• In the abdominal cavity (abdomen) – ascites.
• In the chest cavity. If the lungs are swollen, it is called pulmonary edema, and if fluid has accumulated in the space surrounding the lungs (in the pleural space), it is called pulmonary effusion.

Peripheral edema or ascites is uncomfortable and may indicate a serious illness.Pulmonary edema, which makes it difficult for a person to breathe, is a possible sign of heart failure. It is important to emphasize that chest edema is a potentially life-threatening condition that requires immediate medical attention.

What are the symptoms of dropsy?

Symptoms differ depending on the cause of fluid accumulation. The most common ones include:

• Swelling or swelling of the skin that makes it look tight and shiny.In most cases, this happens to those parts of the body that are closer to the ground (due to gravity). This is why the legs swell. It is worst of all manifested in the lower part of them, especially after a long walk, sitting or standing still. If you press on the swelling area for 5 seconds, a dimple will remain on the skin.
• Fluid also accumulates in the lower back after prolonged lying in bed.
• Symptoms of dropsy with edema of the chest cavity – difficulty breathing or coughing.
• Abdominal enlargement (with ascites).

What are the causes of dropsy?

Among the disorders and diseases due to which fluid accumulates in different parts of the body:

• Chronic venous diseases

This is a very common cause of leg swelling, in which the veins of the lower extremities are not able to pump blood in the direction to the heart. This happens due to damage to the venous valves and leads to the accumulation of fluid in the lower legs, and in some cases, to the formation of sores on the skin.

Also, swelling of the legs appears as a result of the formation of a blood clot in the deep veins of the leg. This disorder is called deep vein thrombosis. In this case, lupus develops in the ankle or foot and usually affects only one leg. If both legs swell, then in this situation the reason may be hidden not in deep vein thrombosis, but in other disorders.

• Swelling during pregnancy

The body of pregnant women retains excess fluid.In this case, puffiness forms on the hands, feet and face. This phenomenon is especially evident towards the end of pregnancy. The accumulation of fluid without accompanying symptoms and disorders is not a sign of toxicosis.

• Menstrual periods

Swelling in women that occurs in cycles (usually once a month) may be the result of hormonal changes associated with the menstrual period. This is a very common condition that goes away on its own and therefore does not require treatment.

• Medication

The accumulation of excess fluid appears as a side effect due to medication. These include some pills for diabetes and high blood pressure, as well as over-the-counter pain relievers (such as ibuprofen) and estrogen medications.

• Diseased kidneys

In a person with diseased kidneys, swelling forms in the lower legs, as well as around the eyes.

• Heart failure

This is a clinical syndrome characterized by a weakening of the pumping function of the heart muscle. Heart failure can cause swelling in the legs and abdomen, as well as fluid buildup in the lungs (pulmonary edema), which can cause shortness of breath. This is a dangerous condition that requires urgent medical attention.

Cirrhosis is a scar formation on the liver that can block blood circulation inside the organ.Often in patients with cirrhosis, the legs swell and ascites is formed.

• Angioneurotic from e to Quincke

A person with this disorder develops swelling of the face, lips, tongue, mouth, throat, throat … Associated symptoms include a hoarse voice, a feeling of tightness in the throat, and difficulty swallowing. Swelling of the throat is especially dangerous, which makes it difficult to breathe.Sometimes this disorder causes swelling of the intestinal walls, which leads to abdominal pain.

This is swelling of the extremities, which most often forms after removal or damage of the lymph nodes. In this case, part of the lymphatic pathways becomes clogged, which prevents the lymph from going through the drainage process. Ultimately, due to the accumulation of lymph, swollen areas are formed.

Treatment of puffiness

In order to understand the reason for the accumulation of fluid, the doctor conducts a physical examination and analyzes the medical history of the patient.Very often, this information is already enough to determine where the swelling comes from. Sometimes diagnostics are prescribed – ultrasound, blood or urine tests.

Not all types of edema require treatment. Fluid buildup associated with pregnancy or menstruation goes away on its own. Also, mild swelling of the legs goes away by itself, especially if a person raises his legs above the level of the heart and fixes them in this position for a while.

To combat more pronounced edema, diuretics are used – drugs that help the body get rid of excess fluid, removing it along with urine.If the swelling is a consequence of any disease, in this case it is necessary to treat the root cause. In the case of taking medications that provoke fluid accumulation, the doctor adjusts the regimen of their intake or selects alternative drugs that do not cause edema.

Listed below are more specific guidelines to help you get rid of some of the excess fluid. Before using them, it is necessary to discuss with the therapist how they are suitable for your particular case.

• Reduce your salt intake

Consuming large amounts of sodium, which is found in table salt and processed foods, increases the accumulation of excess fluid.Reducing the amount of salt in the diet helps to reduce the severity of edema, especially if the person is taking a diuretic along with it.

• Treatment of dropsy with diuretics (diuretics)

Diuretics cause the kidneys to excrete more water and salt, which ultimately reduces swelling. Diuretics should be used with caution and only as directed by a physician. By removing fluid too quickly and too much, they lower blood pressure, leading to dizziness and fainting, and also negatively affect the kidneys.

• Compression stockings

Swelling of the legs can be prevented and treated with compression stockings. They are sold in different shapes and lengths – knee-length, thigh-high, or tights. For most patients, knee-length stockings will work. Compression stockings and tights apply light pressure from the bottom of the leg upward, reducing blood congestion and swelling in the legs. In this case, the effect is achieved only if you wear them regularly.

• Treatment by body position

If the legs, ankles or feet swell, it is necessary to raise the lower limbs above the level of the heart, fixing them in this position for 30 minutes 3-4 times a day. This procedure helps with moderate swelling.

Treatment of puffiness : What should you pay special attention to?

It is very important to protect swollen areas from additional pressure, injury and extreme temperatures.Skin lesions over the edema take a long time to heal and are susceptible to infections.

When you need to seek immediate medical attention:

• Swelling in only one leg (possible sign of deep vein thrombosis),
• Pain in swollen parts of the body,
• Redness or a feeling of intense warmth in the area of ​​edema,
• If an open wound formed,
• Shortness of breath (a possible sign of heart failure) appeared.

If you are worried about puffiness, contact the therapist at the Persomed clinic.We are always guided by our main principle – not just to relieve the patient of symptoms, but to find and cure the root cause of the disorders.

Sources:

1. Edema, Cleveland Clinic,
2. Edema, Mayo Clinic,
3. Oedema (Swelling), Patient.info,
4. Patient education: Edema (swelling) (Beyond the Basics), UpToDate,
5. Lymphedema, Mayo Clinic.

Trophic ulcers

Venous and arterial trophic ulcers of the lower extremities

Trophic ulcers are usually associated with damage to the skin in the lower leg, just above the ankle.They occur in 1 person in 1000 in Europe, more often in older people (20 in 1000), whose age is closer to 80 years.

In 80% of cases, trophic ulcers develop due to venous insufficiency, while diseases of arterial or mixed etiology account for only 20%. If not properly managed, the ulcer can progress to a chronic wound that requires longer treatment (6 months or more) and is characterized by a high recurrence rate.

What are trophic venous ulcers of the lower extremities?

Trophic ulcers of the lower extremities of venous etiology develop due to poor functioning of the valves in large veins, caused by their damage.They can be painless or painful. This disease is also characterized by a high risk of infection. Quite often, trophic ulcers are surrounded by an area of ​​inflammation (dermatitis).

Healthy and well functioning valves provide:

• no stagnation;
• one-way circulation;
• normal blood pressure.

For damaged valves:

• blood accumulates in the legs;
• blood pressure is elevated.

This means that the blood vessels that carry blood back to the heart are not functioning efficiently. Blood accumulates in the peripheral vessels and the pressure in the veins of the lower leg increases, creating conditions for the fluid to exit from the venous vessels into the surrounding tissues. This leads to swelling, thickening, damage to the skin and ulcers as a result.

Risk factors

Those patients who have already suffered from this disease are most at risk of developing trophic ulcers.Other risk factors are:

• varicose veins;
• deep vein thrombosis in the affected leg;

90,096 phlebitis in the affected leg;

90,096 previous fracture, trauma, or surgery;

• heredity;
• symptoms of venous insufficiency: leg pain, heavy legs, pain, itching, swelling, skin destruction, pigmentation and eczema.

Prevention

There are several simple measures that can help reduce the risk of venous trophic ulcers.For example, wearing compression hosiery (stockings), losing excess weight, taking proper care of your skin, playing sports, avoiding harmful excesses (smoking, alcohol).

Compression hosiery

Compression stockings are specially designed to provide metered pressure on the lower extremities, improving blood circulation. They, as a rule, fit tightly to the lower leg and, with distance from it, become looser. This helps to stimulate blood flow from the lower extremities to the heart.For maximum effectiveness, they must be worn at all times (unless the patient is in bed). Compression stockings are selected individually. Additionally, there are various accessories for easy donning.

Excess weight loss

Losing excess weight can help prevent the formation of trophic ulcers of the lower extremities, as being overweight increases pressure in the blood vessels. Obesity significantly increases the risk of developing trophic ulcers compared to people of normal weight.A combination of a balanced diet and regular, moderate exercise can help you lose weight. It is necessary to take walks as often as possible and avoid being in a static position (sitting or standing) for a long time, as well as raise your legs when there is an opportunity for this.

Addressing major issues

Venous disease, associated with varicose veins of the lower extremities, is one of the main causes of trophic ulcers. They can be treated in a variety of ways, which are mainly related to the impact on damaged veins.For example, with the help of a laser, injections that close the lumen of the vessel, or their catheterization. Sometimes, traditional surgery may be required to repair damaged blood vessels or remove them completely.

Treatment of venous ulcers of the lower extremities

Home care for trophic ulcers includes treatment with antiseptic solutions or special medications and systematic dressing. It is very important that the patient and his family are informed that the treatment will only be successful if the compression bandages are worn as directed by the doctor, as the healing efficiency of the ulcer is greatly increased while the compression is maintained.Elevating the legs and other preventive measures can also help speed up wound repair and reduce the risk of recurrence.

What are lower limb arterial ulcers?

Arterial ulcers of the lower extremities are associated with insufficient arterial blood flow. The direct cause of its decrease is arteriosclerosis of the vessel wall and the formation of atherosclerotic plaque, which leads to occlusion of the artery. Peripheral vascular disease associated with arterial insufficiency can lead to tissue ischemia.If this condition progresses, the skin in the lower extremities becomes thin, loses hair, subcutaneous fatty tissue and muscles atrophy, and nails thicken. The legs become pale and cool, pain increases with exertion, and the study of vascular pulsation using palpation is difficult.

Treatment of trophic ulcers of the lower extremities of arterial etiology requires a multidisciplinary approach. It is necessary to ensure sufficient blood flow to the tissues, which is often the tube of the surgical procedure.The patient should maintain a healthy lifestyle in order to improve tissue perfusion.

Risk factors

• Ischemic heart disease
• Previous stroke or transient ischemic attack
• Diabetes mellitus
• Atherosclerosis of peripheral arteries, including Charcot’s syndrome
• Obesity and lack of exercise

Prevention

Lifestyle changes will improve peripheral circulation and help reduce the risk of developing trophic ulcers of the lower extremities of arterial etiology.

Smoking cessation

Smoking greatly reduces tissue perfusion and promotes the development of trophic ulcers. In order to prevent this disease, the patient is advised to quit smoking.

Balanced diet and weight loss

It is important to follow your diet in order to lower blood cholesterol levels. You should exercise as much as possible to help improve blood circulation in your legs. If you feel some pain in the lower extremities during exercise, this is normal.Increased pain can be a sign of narrowing of the lumen of arterial vessels as a result of their atherosclerosis. You need to see a doctor.

Feet care

• Suitable footwear must be worn.
• Keep your feet warm and not injured.
• Daily examination of feet for discoloration or ulceration is recommended.
• The skin must be well hydrated to prevent damage to the skin and the subsequent development of ulcers.

Tetraparesis and edema as a side effect of antifungal therapy: case history

A 72-year-old man has been treated for severe asthma for many years, while maintaining relatively good exercise tolerance. Within two years, the patient developed shortness of breath and productive cough, which required an examination at an immunopathology clinic. Its total immunoglobulin E (IgE) was 680 kU / L at a rate of 20-100 kU / L, and specific IgE to Aspergillus fumigatus was 14.6 kU / L.Computed tomography of the chest organs revealed severe pulmonary emphysema and bronchiectasis. Based on the results obtained, the patient was diagnosed with severe asthma with fungal sensitization (SAFS – Severe asthma with fungal sensitization) and prescribed itraconazole 200 mg twice a day. In addition, the patient was taking: formoterol fumarate (inhalation, 6 mg, one inhalation twice daily), fluticasone (inhalation, 500 mg, one inhalation twice daily) and salbutamol (via a nibulizer 2.5 mg twice daily ).After a month of itraconazole therapy, the patient developed progressive bilateral ankle edema (Fig. 1). Analysis for the level of itraconazole in the blood showed a substance content of 17.5 mg / l (therapeutic range 5-15 mg / l). The dose of the drug was reduced to 200 mg once a day. After a month, the peripheral edema did not go away, and the patient developed weakness in the upper and lower extremities. There were no signs of heart failure, and the plasma level of itraconazole was 9.8 mg / L. Itraconazole was completely canceled, which led to a decrease in swelling of the ankles, but weakness in the limbs persisted and increased.After six weeks, the patient could no longer move and was bedridden, after which he was referred to a neurological center.

Figure 1. Peripheral edema during itraconazole therapy

On admission, the patient was found to have moderate bilateral facial muscle weakness. The tone of the upper limbs was normal, but decreased in both lower limbs. Muscle strength in the lower limbs was significantly reduced – up to 2-3 points out of 5, in the upper limbs up to 3-4 points.Reflexes were absent in all four limbs. Vibration sensitivity was absent up to the tibial tuberosity. The musculoskeletal sense was weakened distally to the level of the metatarsal joints, and tactile sensitivity (tested with pin pricks) was reduced to the mid-calf level. Nerve conduction studies showed a significant weakening of motor and sensory responses without slowing impulse conduction, which corresponded to severe sensory and motor axonal polyneuropathy.

Blood counts were mostly normal, including creatine kinase. The level of lactate dehydrogenase was slightly increased to 490 IU / L (norm 105-333 IU / L), and the level of C-reactive protein – up to 21 mg / L (norm 0-10 mg / L). Thyroid function was normal and serum albumin levels were slightly reduced, varying from 23 to 29 g / L during illness (norm 35-52 g / L). A biopsy of the sural nerve revealed mild axonal neuropathy with signs of a regenerative process without signs of vasculitis.Muscle biopsy (from the anterior tibia) showed changes in muscle tissue characteristic of denervation, and there were no signs of vasculitis either. There were no abnormalities in the analysis of cerebrospinal fluid: leukocytes <1 / μL, glucose 4.8 mmol / L, protein - 0.4 g / L.

Markers of autoimmune processes (IgG antinuclear antibodies, antibodies to smooth muscles, mitochondria, acetylcholine receptor and others) were not detected in the patient’s blood. The erythrocyte sedimentation rate was 70 mm / h (the norm is 0-65 mm / h).Total IgE decreased to 236 kU / L (was 680 kU / L), aspergillosis-specific IgE decreased to 6.84 kU / L (previously 14.6 kU / L), which indicated a good response of the patient to itraconazole. Although axonal Guillain-Barré syndrome (an autoimmune lesion of peripheral nerves) was suspected at the initial stage of differential diagnosis, the results of immunological studies and the subsequent course of the disease made the most likely diagnosis of itraconazole-induced neuropathy.

In neurology, the patient received supportive therapy, followed by active neurorehabilitation.A gradual improvement in the condition occurred within two months, after which the patient was discharged. After another six months, the man was able to walk on his own with the help of two elbow crutches. Muscle strength returned to 5/5 in the distal upper and lower extremities and 4/5 in the proximal.

Discussion

Itraconazole is an antifungal agent widely used to treat several forms of mycosis. It was the first oral drug to be active against Aspergillus species [1].Itraconazole is a synthetic triazole antifungal agent that was first discovered in 1980 and licensed in 1991 for the treatment of invasive aspergillosis and some endemic mycoses such as histoplasmosis and sporotrichosis. It has been widely used for the treatment of various allergic, skin and systemic mycoses, as well as for the treatment and prevention of fungal infections in hematological patients and patients after transplantation [1]. It is also effective in allergic bronchopulmonary aspergillosis (ABPA) and in severe asthma with fungal sensitization (SAFS) [2, 3], which has been diagnosed in the patient.Side effects are rare (less than 7%) and are usually minor [4, 5, 6]. Mild peripheral neuropathy is recorded with a frequency of less than one in 10,000 [4]. There are numerous reports of cases of itraconazole-enhanced neuropathy during therapy with vincristine, the cases being explained by a slowdown in the metabolism of vincristine by itraconazole [8, 9, 10]. A case of painful neuropathy in a patient with type 1 diabetes mellitus has been described [11]. However, severe neuropathy solely due to itraconazole without any associated risk factor, as in this case, has not yet been reported.

In recent years, itraconazole has been increasingly used for the treatment of ABPA and SAFS [2, 3]. Itraconazole is generally well tolerated, with only mild side effects reported [4, 5, 6]. In clinical trials, the overall incidence of adverse events is about 7% with short-term use and up to 15% with long-term use – the most common are gastrointestinal side effects [4, 6]. Ankle edema is a rare complication of itraconazole therapy – up to 4% of patients in clinical trials [7], and patients receiving concurrent calcium channel blockers are more likely to suffer.The mechanism of this side effect remains unknown. Severe edema requiring discontinuation of medication, as in the case described, is a rare event that has been reported only once [7]. Although hypoalbuminemia (range 23-29 g / L) was present, possibly aggravating the edema, it alone should not have caused the swelling seen in this case.

Among other azole drugs in the literature, there are at least four reports that voriconazole causes a painful form of peripheral neuropathy [12, 13, 14].Posaconazole, although highly lipophilic, has not been cited as an exclusive cause of neuropathy, but there is evidence that it potentiates vincristine-induced neurotoxicity [15, 16].

Several facts support the diagnosis of itraconazole-induced neuropathy. First, there is a significant temporal relationship between the onset of ankle edema and neuropathy after starting itraconazole and gradual recovery after stopping the drug. The temporal and dose-dependent picture of axonal sensorimotor polyneuropathy is characteristic of drug neuropathy [17].Second, although the patient’s clinical signs could indicate an axonal variant of Guillain-Barré syndrome, a normal protein level in the cerebrospinal fluid eliminated this diagnosis.

The following mechanism of neuropathy development is theoretically possible in this case. Itraconazole is a cytochrome inhibitor with high lipophilicity and high ability to bind to plasma proteins (99%) [18, 19]. The concentration of itraconazole in tissues is two to ten times higher than the concentration in plasma.This makes the drug effective, despite the low plasma concentration of itraconazole in some patients. Our patient initially had a high plasma concentration of itraconazole despite the standard dosage. The tissue concentration was probably even higher, which led to the development of the neurotoxic effect. The subsequent slow elimination caused a slow gradual recovery of neurons, despite early discontinuation of the drug [20]. In general, the concentration of itraconazole in plasma depends not only on the dose, but also on the biochemical characteristics of the patient, the metabolism of the drug in the liver and enterohepatic circulation [21].Therefore, the initial dosage cannot predict the plasma concentration of the drug on a case-by-case basis. Therefore, it is prudent to control the concentration of itraconazole after the first dose and to carry out further monitoring as the dose is increased.

Written informed consent was obtained from the patient for publication. A copy of the written consent is available for review and is located by the editor-in-chief of the journal .

1. Polak A: Antifungal therapy – state of the art at the beginning of the 21st century.Prog Drug Res. 2003, Spec. No. 59-190
2. Denning DW, O’Driscoll BR, Hogaboam CM, Bowyer P, Niven RM: The link between fungi and asthma – a summary of the evidence. Eur Respir J. 2006,27 (3): 615-626. 10.1183 / 0

   36.06.00074705.

3. Denning DW, O’Driscoll BR, Powell G, Chew F, Atherton GT, Vyas A, Miles J, Morris J, Niven RM: Randomized Controlled Trial of Oral Antifungal Treatment for Severe Asthma with Fungal Sensitization: The Fungal Asthma Sensitization Trial ( FAST) Study.Am J Respir Crit Care Med. 2009, 179 (1): 11-18. 10.1164 / rccm.200805-737OC.
4. Sporanox data sheet. http://medsafe.govt.nz/profs/Datasheet/s/Sporanoxcap.htm
5. Tucker RM, Haq Y, Denning DW, Stevens DA: Adverse events associated with itraconazole in 189 patients on chronic therapy. J Antimicrob Chemother. 1990,26 (4): 561-566. 10.1093 / jac / 26.4.561.
6. Böhme A, Just-Nübling G, Bergmann L, Shah PM, Stille W, Hoelzer D: Itraconazole for prophylaxis of systemic mycoses in neutropenic patients with haematological malignancies.J Antimicrob Chemother. 1996,38 (6): 953-961.
7. Tailor SA, Gupta AK, Walker SE, Shear NH: Peripheral edema due to nifedipine-itraconazole interaction: a case report. Arch Dermatol. 1996, 132 (3): 350-352. 10.1001 / archderm.132.3.350.
8. Jeng MR, Feusner J: Itraconazole-enhanced vincristine neurotoxicity in a child with acute lymphoblastic leukaemia. Pediatr Hematol-Oncol. 2001, 18 (2): 137-142. 10.1080 / 088800101300002973.
9. Bashir H, Motl S, Metzger ML, Howard SC, Kaste S, Krasin MP, Hudson MM: Itraconazole-enhanced chemotherapy toxicity in a patient with Hodgkin lymphoma.J Pediatr Hematol-Oncol. 2006,28 (1): 33-35.
10. Bermúdez M, Fuster JL, Llinares E, Galera A, Gonzalez C: Itraconazole related increased vincristine neurotoxicity: case report and review of literature. J Pediatr Hematol Oncol. 2005,27 (7): 389-392.
11. Singh R, Cundy T: Itraconazole-induced painful neuropathy in a man with type 1 diabetes. Diabetes Care. 2005, 28 (1): 225-10.2337 / diacare.28.1.225.
12. Tsiodras S, Zafiropoulou R, Kanta E, Demponeras C, Karandreas N, Manesis EK: Painful peripheral neuropathy associated with voriconazole use.Arch Neurol. 2005, 62 (1): 144-146. 10.1001 / archneur.62.1.144.
13. Aksoy F, Akdogan E, Aydin K, Yilmaz M, Altunayoglu V, Sozen EE, Omay SB, Koksal I: Voriconazole induced neuropathy. Chemotherapy. 2008, 54 (3): 224-227. 10.1159 / 000140466.
14. Gendrot A, de La Blanchardière A, de La Gastine B, Fromager G, Massias L, Verdon R: Painful peripheral neuropathy associated with voriconazole during the treatment of chronic cavitary pulmonary aspergillosis. Rev Med Interne. 2010, 31 (2): 163-166.10.1016 / j.revmed.2009.02.021.
15. Jain S, Kapoor G: Severe life threatening neurotoxicity in a child with acute lymphoblastic leukemia receiving posaconazole and vincristine. Pediatr Blood Cancer. 2010, 54 (5): 783-10.1002 / pbc.22399.
16. Eiden C, Palenzuela G, Hillaire-Buys D, Margueritte G, Cociglio M, Hansel-Esteller S, Peyriere H: Posaconazole-increased vincristine neurotoxicity in a child: a case report. J Pediatr Hematol Oncol. 2009, 31 (4): 292-295. 10.1097 / MPH.0b013e31819b9d01.
17. Peltier AC, Russell JW: Recent advances in drug-induced neuropathies. Curr Opin Neurol. 2002,15 (5): 633-638. 10.1097 / 00019052-200210000-00015.
18. Leyden J: Pharmacokinetics and pharmacology of terbinafine and itraconazole. J Am Acad Dermatol. 1998, 38 (5 Pt 3): S42-S47. 10.1016 / S0190-9622 (98) 70483-9.
19. Willems L, van der Geest R, de Beule K: Itraconazole oral solution and intravenous formulations: a review of pharmacokinetics and pharmacodynamics. J Clin Pharm Ther.2001, 26 (3): 159-169. 10.1046 / j.1365-2710.2001.00338.x.
20. Prentice AG, Glasmacher A: Making sense of itraconazole pharmacokinetics. J Antimicrob Chemother. 2005, 56 (suppl 1): i17-i22. 10.1093 / jac / dki220.
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90,000 Swelling on the legs inexpensive treatment in Kiev

Swelling of the legs is the accumulation of excess fluid in the tissues.

Signs of danger of developing leg edema (if you have the following symptoms):

– An increase in the volume of the limbs, the appearance of bags under the eyes, especially in the morning.

What should be done at the beginning of the development of leg edema?

– Consult a cardiologist, neurologist.

Consequences of lack of treatment for edema on the legs at the onset of the disease:

– Hardening of the subcutaneous tissue, thinning of the skin, poor healing of wounds on the legs.

Our comprehensive approaches to the diagnosis of edema on the legs

Comprehensive non-invasive diagnostics includes:

1. Ultrasound diagnostics of the main and peripheral arteries and veins of the regional basins of the head, liver, kidneys, extremities
2. Capillaroscopy of the smallest vessels of the body
3. ECG screening of ischemic changes in the myocardium
4. Electroencephalography – evaluation of brain function
5. Physical examination
6. Neurological examination
7. Examination by a rehabilitation therapist – assessment of the adaptability of the vascular system to physical and emotional stress
8. Psychodiagnostics to exclude the psychosomatic origin of the disease and the effect of recorded emotional overloads on the vascular system

What is the advantage of diagnostics and relaxation on legs in our clinic

The clinic works on innovative technologies d.M.Sc. Lushchik U.B., developed at the Scientific Center “Veritas” and owns the author’s innovative approaches to the diagnosis and treatment of the whole organism, which have been successfully used in the medical services market since 1996:

1. An integrated approach to assessing the pathology of the whole body
2. Emphasis on the study of the vascular system of the body as the main blood supply to organs and systems
3. Exclusive technologies for studying the state of the venous system of the body as a system of outflow from organs – a prototype of the sewerage system in the body
4. Assessment of the body’s work at the level of sufficiency of blood supply, the functioning of an organ or system
5. Assessment of the body’s adaptability and the adequacy of its work in conditions of physical and psycho-emotional stress
6. Assessment of the logic of health-improving (sanogenic) or pathological adaptations of the body to certain changes in the environment (meteotropy, meteosensitivity, meteopathies)
7. Understanding the logic of the body’s actions in certain diseases

Treatment programs for leg edema in our clinic

Swelling of the legs requires an individual approach to the diagnosis of the state of the entire cardiovascular system.Only after examining all segments in the vascular water supply system “heart-arteries-capillaries-veins-heart” can the treatment of edema in the legs begin.

The effectiveness of the treatment of leg edema in our clinic

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