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					Occasionally occurs with ascities and pleural effusions. Edema is usually “dependent,” with lower
extremity edema at the end of the day and periorbital and finger edema upon awakening

D. Acute glomeruloneohritis. Edema can occur with any form of acute glomeruloneohritis. It is usually of
mild to moderate degree.

E. Idiopathic recurrent edema. This syndrome of unknown cause occurs chiefly in women and is
characterized by recurrent edema, irritability, and headaches. Edema may be cyclic or persistent and
most often occurs in the lower extremities.

F. Drugs. Edema may occur as a side effect of estrogen-containing drugs or vasodilator drugs such as
minoxidil.

G. Pregnancy. Preeclampsia-eclampsia is characterized by edema, hypertension and proteinuria. Some
degree of lower extremity edema can be detected in most uncomplicated pregnancies as well.

II. General treatment. Treatment of edema as such consists mainly of dietary sodium restriction and
diuretic therapy.

    A. Dietary sodium restriction. In the USA the average daily diet contains 3-6g og sodium.(For
       reference, 1g of salt[ NaCl ] contains 17meq of sodium, and ther are about 44 meq of sodium in
       1g of sodium). Dietary sodium restrictions of 1-3 g/d are prescribed depending on the severity of
       the underlying disease. Diets containing less than 1 g of sodium may be prescribed but are
       extremely unpalatable. In patients receiving diuretic therapy and a salt restricted diet, fluid
       restriction to 1500mL/d may be necessary to prevent hyponatremia.
    B. Diuretics. Diuretics are useful for their natriuretic effect, with subsequent increased renal
       fractional exertion of salt and water. Diuretics are potent drugs and should be used with caution
       .Except in the case of acute pulmonary edema, dieresis should be done gradually, with dial
       weight losses of no more than 0.5-1 kg/d. Rapid dieresis or overdiuresis results in intravascular
       volume depletion and findings of weakness, dizziness, orthostatic hypotension and an elevated
       BUN and serum creatinine.
           1. .Carbonic anhydrate inhibitors. These drugs inhibit carbonic anhydrase and
                subsequently Na+/H+ exchange, primarily in the proximal tubule. They are week
                natriuretic agents that result in excretion of an alkaline urine and mild metabolic
                acidosis. The main drug in this category is acetazolamide. An Initial dose of 250-375 mg
                daily is given until a response is seen. The dosing interval is then changed to every other
                day. Acetezolamide may be used to alkaline the urine in patients with uric acid
                nephrolithiasis.It is generally not useful in the treatment of edema.

				
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posted:7/24/2012
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