hypervolemia (extracellular volume overload)

Etiology

• Na+ retention
  • renal failure
    • acute renal failure
    • chronic renal failure
  • endocrine causes generally not associated with edema
    • hyperaldosteronism
    • syndrome of inappropriate antidiuretic hormone (SIADH)
    • Cushing's syndrome
• decreased effective circulating volume
  • diminished cardiac output
    • myocardial infarction
    • cardiomyopathy
    • hypertensive emergency
    • cor pulmonale
  • cirrhosis
  • nephrotic syndrome
• excessive fluid administration
  • IV fluids
  • parenteral nutrition
  • sodium-containing penicillins

Indications

• pericardial tamponade
• venous lymphatic obstruction
• venous thrombosis
• idiopathic lymphedema

Clinical manifestations

• fatigue
• dependent edema
• dyspnea*
  • exertional dyspnea
  • paroxysmal nocturnal dyspnea
  • resting dyspnea
  • orthopnea
• tachypnea
• tachycardia
• pulmonary crackles
• S3 heart sound
• increased weight
• jugular venous distension (JVD)*
• hepatojugular reflex
• pleural effusion
• subungual edema
• hypotension
• low pulse pressure
• early satiety
• signs & symptoms resulting from specific etiology

Laboratory

• serum chemistries
  • urea nitrogen increased in renal failure, normal in nephrotic syndrome
  • creatinine increased in renal failure, normal in nephrotic syndrome
  • albumin decreased in nephrotic syndrome & cirrhosis
  • K+ decreased in hyperaldosteronism
  • bilirubin increased in cirrhosis
  • cholesterol decreased in cirrhosis, increased in nephrotic syndrome
• urinalysis
  • specific gravity
  • protein
• fractional excretion of sodium (FENA) or chloride
• 24 hour urine protein

Radiology

• chest X-ray
  • pulmonary vascular redistribution*
  • may show pulmonary edema
• echocardiogram
• abdominal ultrasound

* most important indicators of volume overload

Management

• Na+ restriction
• water restriction
• diuresis
• hemodynamic monitoring if indicated
• discontinue medications that interfere with Na+ secretion of cardiac output
  • non-steroidal anti-inflammatory drugs (NSAIDs)
  • negative inotropes
• removal of fluid may provide temporary relief of symptoms & diagnostic information
  • paracentesis
  • thoracentesis
  • hemodialysis
• treatment of pulmonary edema
  • oxygen
  • nitrates
  • morphine
• bedrest is the safest diuretic
• treat underlying etiology when patient is hemodynamically stable

More general terms

• fluid imbalance; water imbalance

More specific terms

• transfusion-associated volume overload; transfusion-associated circulatory overload (TACO)

Additional terms

• cardiomyopathy
• Cushing's syndrome; hypercortisolism; hyperadrenocorticism; pluriglandular syndrome
• heart failure (HF)
• hyperaldosteronism
• hypertension (HTN, high blood pressure, HBP)
• nephrotic syndrome
• renal failure; kidney failure
• syndrome of inappropriate antidiuretic hormone; SIADH; nephrogenic syndrome of inappropriate antidiuresis; NSIAD