Bilateral pedal edema
Background
- Definition: existence of the excess fluid in the lower extremity resulting in swelling of the feet and extending upward
- Further classified as pitting (depress-able) and non-pitting
Causes Pedal Edema
Mechanisms of Pedal Edema
- Increased hydrostatic pressure
- Decreased oncotic pressure
- Increased capillary permeability
- Lymphatic obstruction
Clinical Features
Pitting pedal edema
- Pedal edema
Differential Diagnosis
Bilateral pedal edema
Differential Diagnosis of Pedal Edema
- Gravitational
- Venous insufficiency/thrombophlebitis
- Drugs
- CHF
- Lymphedema
- Pretibial myxedema
- Renal failure
- Liver failure
- DVT
- Idiopathic
Evaluation
Diagnosis
- Idiopathic edema is a diagnosis of exclusion, must first rule out CHF, cirrhosis, renal failure, nephrotic syndrome, chronic venous insufficiency, and medication-induced edema[1]
Management
- Treatment is based on addressing underlying disease process
- Idiopathic pedal edema need not to be treated with diuretics
Disposition
- If no respiratory symptoms, most patients may be safely discharged home
- Patients should be followed up in medical clinic for further investigation and care
See Also
External Links
References
- Kay A, Davis CL. Idiopathic Edema. American Journal of Kidney Disease. 1999; 34(3): 405-408.
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