Fluid balance/edema

All dying people become hypoalbuminemic due to cachexia/anorexia as their illness progresses and therefore become edematous. In malignancies, venous or lymphatic congestion may also play a role. Patients with clinical edema are not dehydrated; they have excess quantities of total fluid and salt. With time, they may be able to reabsorb them, though not as efficiently as normal. When artificial hydration is used, edema will become worse.

Assessment

Assessment for edema should consider the following:

• urine output;
• patient weight;
• peripheral or orbital edema;
• change in neurological status;
• monitor fluid and electrolytes.

Management

Non-Pharmacological Interventions

• Limit fluid intake.
• Increase intake of salty foods.
• Elevate feet when sitting.
• TEDS stockings to improve venous return.
• Watch for skin breakdown since edema will cause stretch and ultimately increase skin fragility.
• If bedridden, try to reposition frequently.

Pharmacological Interventions

Diuretics

Consider:
Furosemide

Metolazone: may be a useful adjunct to Furosemide if difficult to diurese

Spironolactone: Need to watch for potassium retention and should avoid in renal failure

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This page was last updated: March 8th, 2005 at 5:54pm.