Generalized edema is the excessive accumulation of interstitial fluid throughout the body, often indicating severe systemic illness. It ranges from mild, barely detectable swelling to massive, easily observed anasarca. Common causes include cardiac, renal, hepatic, endocrine, or lymphatic disorders, malnutrition, burns, certain medications, and post-mastectomy changes.

Pathophysiology

Edema arises from disruption of normal fluid balance between intravascular and interstitial spaces. Four primary pressures govern fluid movement across capillary membranes:

• Capillary hydrostatic pressure – pushes fluid out of capillaries

• Interstitial fluid pressure – opposes fluid movement into interstitium

• Plasma osmotic pressure – pulls fluid into capillaries

• Interstitial osmotic pressure – draws fluid out of capillaries

Edema occurs when these pressures are imbalanced due to:

• Increased capillary permeability

• Lymphatic obstruction

• Persistently elevated capillary hydrostatic pressure

• Decreased plasma protein levels (hypoalbuminemia)

• Dilation of precapillary sphincters

Signs and Symptoms

• Symmetrical or generalized swelling of extremities, face, trunk, and sacral areas

• Pitting or nonpitting edema depending on cause

• Weight gain and bloating

• Dyspnea, orthopnea, or fatigue if associated with cardiac or renal dysfunction

• Skin changes: taut, shiny, or stretched appearance; risk of breakdown in dependent areas

Clinical Assessment

History

• Onset, duration, and progression of swelling

• Daily variation and positional effects

• Associated symptoms: shortness of breath, pain, urine changes

• Past medical history: cardiac, renal, hepatic, endocrine, burns, malnutrition

• Dietary habits and recent fluid or sodium intake

• Medication history: diuretics, corticosteroids, NSAIDs, IV fluids

Physical Examination

• Inspect and palpate extremities, back, sacrum, and hips for edema

• Assess for symmetry, pitting, and ecchymoses

• Evaluate peripheral pulses, capillary refill, and temperature

• Cardiac and respiratory assessment for heart failure or pulmonary congestion

• Monitor weight, jugular venous pressure, and signs of organ involvement

Medical Causes

Other Causes

• Drugs: corticosteroids, NSAIDs, estrogens, antihypertensives

• Treatments: IV saline or nutritional infusions leading to fluid overload

Special considerations

• Elevate limbs above heart level to promote drainage

• Reposition frequently to prevent pressure ulcers

• Oxygen administration if dyspnea develops

• Skin care for dependent areas using pressure-relief devices

• Fluid and sodium restriction; diuretics or IV albumin as indicated

• Monitor intake/output, daily weight, and serum electrolytes

• Prepare for diagnostic tests: blood and urine analysis, ECG, echocardiography, imaging

Patient Counseling

• Educate on signs and symptoms that require urgent reporting

• Advise dietary modifications to limit sodium and fluid overload

• Encourage adherence to prescribed medications and monitoring plans

Pediatric Pointers

• Renal failure and protein-energy malnutrition (e.g., kwashiorkor) are common causes

• Monitor fluid balance closely; fever or diaphoresis may cause rapid fluid shifts

Geriatric Pointers

• Older adults are at higher risk due to reduced cardiac and renal function and poor nutritional status

• Exercise caution with IV fluids and sodium-containing medications

References

1. Barrera F, George J. Non-alcoholic fatty liver disease: More than just ectopic fat accumulation. Drug Discov Today. 2013;10(1–2):e47–e54.

2. Musso G, Gambino R, Cassader M. Non-alcoholic fatty liver disease from pathogenesis to management: An update. Obes Rev. 2010;11(6):430–445.