We often encounter such female patients who go to the doctor for facial or lower extremity swelling, go to big hospitals, see specialists and doctors, and do laboratory tests, but no disease can be detected. Then, this kind of patient may be idiopathic edema.
Idiopathic edema is characterized by water and/or sodium retention of the lower extremities, trunk, and face, the cause of which is not fully understood. It is commonly seen in middle-aged and young women, less commonly in men, and also in more severe cases of simple obesity. Edema is often aggravated by mental stress or prolonged standing activities or sitting, and is reduced after lying or sleeping, and is aggravated in some patients before menstruation. By medical history, physical examination and laboratory tests, there are no organic lesions of the heart, liver, kidney, endocrine system, etc.
It may be related to the following factors.
1, insufficient sympathetic excitation in the upright position, reduced glomerular filtration rate, and increased secretion of aldosterone.
2, mental stress, or increased secretion of antidiuretic hormone when smoking, resulting in water retention.
3, Increased sensitivity of renal tubules to antidiuretic hormone and decreased sensitivity to natriuretic factor.
4, Relative increase of estrogen/progesterone ratio, causing sodium retention.
5, Microvascular basement membrane, especially in the lower limbs, has increased permeability.
6, Blood and lymphatic return to the lower extremities is affected in obese patients.
Clinical manifestations.
1, edema or swelling: common in post-pubertal women, mostly after standing activities or in the afternoon, foot, ankle, pretibial depressed edema, and some patients have morning eyelid, facial swelling, distal swelling of the upper limbs; the occurrence of edema in some patients is related to hot climate or menstrual cycle. The weight increases at night before going to bed compared with that at waking up in the morning, and the edema disappears and the weight decreases after sleeping overnight.
2. Obesity: about half of the patients with idiopathic edema have obesity, and edema further increases the weight of patients.
3, headache: due to intracranial edema can lead to headache in patients.
4.Some patients due to microvascular disorders may have generalized pain similar to rheumatism after prolonged uprightness.
5.Upright hypotension and autonomic dysfunction may appear.
If you encounter a similar problem and the disease of the major organs is ruled out in the regular hospital examination, then the diagnosis of idiopathic edema can be made.
Because the etiology is not clear, but the invariable cause of edema is water and sodium retention, you are advised to pay special attention to the following points.
1. Measure your weight once a day in the morning and once at night before going to bed, and try to measure it at the same time, such as 7:00 a.m. and 10:00 p.m., and then record it;
2, accurate measurement of daily water intake (including the amount of soup, porridge and other fluids drunk during meals) and urine volume, as far as possible at the same time, such as from 7:00 a.m. to 7:00 p.m. the next day, and then record it, pay attention to observe whether the more water intake the more powerful edema;
3. If possible, record the amount of salt you consume every day, without deliberately limiting it, but pay attention to whether the more salt you consume, the more obvious the edema becomes;
4. Observe whether the edema of both lower extremities is stronger after standing for a long time, and whether the swelling of the face is strong when you wake up in the early morning but can be reduced in about half an hour when you get up and move around, and record the results.
After recording for half a month, take the results to your doctor, and your doctor will have a good idea, for example, whether to recommend dietary modification? Should you use diuretics? What diuretic to use? How much to use? At what time of day? Do you need any other medication to support your treatment? These questions can be easily answered. It is difficult to record these questions in the hospital, so the patient has to do it at home, but the data is very important and costs almost nothing, so you must actively cooperate.
This type of problem must identify a doctor and have a long communication contact with him (not that a certain clinic for a long time), so that he can have a deep impression of your condition, remember not to see this doctor today and that one tomorrow, in the end no doctor is clear about your condition.
In conclusion, idiopathic edema has no exact cause, but objectively there is impaired water and salt metabolism and water and sodium storage, it is not a fatal disease and often does not have serious consequences. Although there is no specific treatment, it is possible to precisely regulate and achieve a balance of water and salt metabolism through dietary modification and appropriate medication, but the patient has to have a certain understanding of the disease and be able to actively and positively cooperate with the doctor’s treatment.