Clinical Nutrition: Edema

So today was the first day of my 2-week clinical rotation at Mon General Hospital. I followed a Registered Dietitian around today, which included going on rounds and speaking to patients referred by a physician or nurse.  One simple clinical term I came across today was edema.  Edema is an abnormal accumulation of fluid in the intercellular tissue spaces or body cavities.  The edema I saw today was present in the feet and ankles, but edema can also be found on other places in the body, such as periorbitally, or around the eyes.  (I didn’t include a photo in this blog, but if you feel like googling “pitting edema,” go right ahead!)

Edema can happen when fluid intake exceeds fluid loss, and can lead to a rapid weight gain. Just a weight gain of 2.2 pounds can mean 1 liter of fluid retention. So if a patient has gained 25 pounds in the last week, it could mean that the patient has retained 11 liters of water in their intercellular tissue spaces or body cavities.

The disease states associated with edema include cardiac failure, hypoalbuminemia (albumin osmotic force- lower albumin releases water into tissue spaces), malnutrition, liver failure, or kidney failure.  These conditions can cause a patient’s body to hold onto excess sodium and water.  In heart failure, renal blood flow is decreased.  This leads to renal retention of sodium and water in order to increase blood flow.  In addition, edema can also be caused by rapid administration of fluids, especially intravenous (IV) fluids.  Edema is treated with diuretics, which can rid the body of excess water. Low-sodium diets can also given to the patients, at 2g or less per day.

Pitting edema is measured on a 4-point scale, with 1+ being the least severe edema and 4+ being the most severe. A physician can press a finger onto the patient’s site of edema and a “pit” will form which will remain indented for anywhere from a brief second to over 30 seconds.  Examples of the 4-point scale are included below:

Pitting Edema – measurement

1+
Barely detectable impression when finger is pressed into skin.   
2+
Slight indentation.15  seconds to rebound
3+
Deeper indentation. 30  seconds to rebound.
4+
> 30  seconds to rebound.

O’Sullivan, S.B. and Schmitz T.J. (Eds.). (2007). Physical rehabilitation: assessment and treatment (5th ed.). Philadelphia: F. A. Davis Company. p.659


1+
2mm depression, barely detectable.Immediate rebound.
2+
4mm deep pit.A few seconds to rebound.
3+
6mm deep pit.10-12 seconds to rebound.
4+
8mm: very deep pit.>20 seconds to rebound.

Hogan, M (2007) Medical-Surgical Nursing (2nd ed.). Salt Lake City: Prentice Hall

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