What is an anasarca?
Anasarka – this is an extreme degree of edematous syndrome, characterized by a pronounced fluid retention in the tissues and cavities of the body:
Legs, feet and thighs;
Torso
Sexual organs;
upper limbs;
face and neck;
Lungs and pleural cavity;
pericardial cavity;
Abdominal cavity.
The term anasarca was introduced specifically to focus on the critical state of the body, requiring urgent action. Diffuse swelling of peripheral tissues does not pose a direct threat to the body. The accumulation of fluid in the cavities (polyserositis) is not so harmless, since a large amount of it disrupts the functioning of the internal organs caused by their compression. Especially dangerous in this respect is compression of the lungs and diaphragm with a decrease in respiratory excursion, which causes ventilation failure and increased hypoxia.
Causes of anasarca
The mechanisms of tissue impregnation with fluid from the vascular space can be associated with:
Increased hydrostatic blood pressure on the vascular wall;
Stagnation of blood in the vascular bed;
Fragility and increased permeability of the vascular wall;
Decreased oncotic and osmotic pressure of plasma;
Redistribution of the ionic composition of blood and intercellular fluid in the form of sodium retention in tissues.
The listed mechanisms can work in such diseases:
Decompensated heart disease with severe congestive heart failure (heart attack, myocarditis, various types of cardiomyopathies, cardiac arrhythmias, and others);
Kidney and the excretory system, accompanied by renal failure or impaired urodynamics and urine outflow (nephrotic and nephritic syndromes in glomerulonephritis, pyelonephritis, urolithiasis, renal amyloidosis);
Endocrine pathology in the form of hypothyroidism. The critical form of this disease is called myxedema. It ends with a sharp decrease in the level of protein in the plasma, which causes fluid loss due to osmotic leakage into the tissue;
Hyperaldosteronism. All diseases of the adrenal glands, accompanied by an increase in the synthesis of mineralocorticoids (aldosterone) cause electrolyte disturbances in the body in the form of sodium retention with its concentration in the intercellular space, which leads to an increase in osmotic pressure relative to plasma;
Allergic reactions. They very rarely cause anasarca, which grows at lightning speed and is called Quincke’s edema. Particularly dangerous in this case is swelling of the respiratory tract (larynx).
Anasarca symptoms
The clinical picture of anasarca can develop gradually or progressively. In most cases, you have to deal with the first variant of the disease.
It notes:
Edema syndrome. It consists in widespread severe edema of all segments of the body. First, the legs and feet swell. In people with renal pathology, the primary distribution of edema from the face and upper limbs is possible. Over time, the genitals and torso swell. You can confirm the presence of swelling of the tissues by pressing on them with your finger. The deeper the trace after this, the more pronounced the edematous syndrome;
Dyspnea. With anasarca, it always occurs. It is caused by the accumulation of fluid in the pleural cavity (hydrothorax) and its stagnation in the pulmonary circulation. It does not manifest itself for a long time, arising only with severe compression of both lungs. Patients should be alerted by symptoms in the form of a feeling of lack of air during exertion, which gradually decrease until shortness of breath at rest;
Cardiomegaly. With anasarca of cardiac origin, a sharply enlarged heart is always recorded. This is a consequence of myocardial hypertrophy and fluid accumulation in the pericardial cavity.
Treatment of anasarka
The possibilities and scope of therapeutic measures for anasarca depend on the cause of its occurrence. In no case should you:
flood the body;
Take products containing sodium;
Do not act in terms of assistance.
Treatment for anasarca should include:
Dehydration of the body. It is achieved by intensive intravenous diuretic therapy with high doses of loop diuretics (trifas, lasix, furosemide). Appointed in all cases of anasarca, regardless of origin;
cardioprotective therapy. With cardiac pathology, it is imperative to strengthen the heart muscle. Cardiac glycosides (digoxin, strophanthin, corglicon) and metabolic drugs (mildronate, metamax, ATP) can help with this;
Plasma hemodialysis and ultrafiltration. Indicated in anasarca of renal origin. Such measures may be the only way out of the current situation;
Glucocorticoids and antihistamines (dexamethasone, methylprednisolone, tavegil, suprastin). Indicated for anasarca of allergic origin. Hormones can be used as membrane stabilizers of vascular walls in other types of anasarca;
Increased plasma oncotic pressure. Definitely required for myxedema. It is achieved by infusions of plasma and albumin. In the future, hormone replacement therapy with L-thyroxine is prescribed.