- Increased plasma volume due to renal sodium retention
- Heart failure
- Renal failure
- Urinalysis (red cell casts), elevated BUN and creat
- Nephrotic syndrome
- Periorbital edema
- Hypoalbuminemia, heavy proteinuria
- Venous obstruction or insufficiency
- Cirrhosis
- Venous thrombosis
- Chronic venous insufficiency - post-thrombotic syndrome
- Arteriolar vasodilation
- Drug-induced
- Vasodilators (CCB, hydralazine, minoxidil)
- Thiazolidinediones (for diabetes) and NSAIDs can worsen edema from CHF or cirrhosis
- Deep vein thrombosis
- Venous insufficiency
- Brown hemosiderin deposits
- Lymphedema
- History of surgery
- Kaposi-Stemmer sign: inability to pinch a fold of skin at dorsum proximal second toe is a sign of lymphedema
- Lymphedema or pretibial myxedema
- CBC, electrolytes, creatinine, LFT, TSH, albumin
- UA, consider urine microscopy
- Consider D-dimer
- Consider echocardiography
- If chronic venous insufficiency, mobilization, leg elevation and 30-40mmHg compression stockings
- ABI prior to compression therapy if arterial insufficiency (normal 0.8-1.2)
- Consider horse chestnut seed extract 200mg (50mg escin) BID
- If volume overload, consider loop diuretic eg. furosemide 20-40mg PO daily
- In cirrhosis, add spirinolactone 50-100mg PO daily (can go up to QID) to loop diuretic to prevent hypokalemia
- If resistant, consider thiazide (metolazone)