Volume Overload
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Introduction
The Case of...
a simple case introducing clincial presentation and calling for a differential diagnosis to get students thinking.
Causes and Risk Factors
Volume expansion occurs when salt and water intake exceeds renal and extrarenal losses.
Primary renal sodium retention, leading to increased effective circulating volume, occurs with:
- acute renal failure
- acute glomerulonephritis
- severe chronic renal failure
- nephritic syndrome
- nephrotic syndrome
- primary hyperaldosteronism
- Cushing's syndrome
- easrly stages of severe liver disease
- Conn's syndrome
- Gordon's syndrome
- Liddle's syndrome
Secondary renal sodium retention, leading to decreased effective circulating volume, occurs with:
- heart failure
- late stages of severe liver disease
- nephrotic syndrome (minimal change disease)
- pregnancy
Pathophysiology
The net effect of causes of sodium and water retention is increased capillary hydrostatic pressures which shift fluids from the vasculature to the interstitial space.
Signs and Symptoms
- history
- physical exam
History
Physical Exam
cardiovascular
- Increased JVP
- normal/increased blood pressure
- S3
respiratory
- inspiratory crackles
skin
- normal/increased skin turgor
- edema in ankles/sacral areas
Investigations
- lab investigations
- diagnostic imaging
Lab Investigations
decreased hematocrit and serum protein
Diagnostic Imaging
Differential Diagnosis
Treatments
Dietary sodium restriction in combination with diuretics is the mainstay of treatment.
Consequences and Course
Resources and References
Topic Development
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