Approach to Edema in Paediatric medicine. Physiology remains the same with Adult medicine.

1. Approach to
Edema
In Paediatrics
Angel Govekar
Roll No. 25
MBBS IV
DPU, Pune

2. In Edema, we’ll discuss:
● Physiology
● Causes of Edema
● Approach to Localised Edema
● Approach to Generalized Edema
● Investigations
● Treatment
● Approach
● Summary

3. Arteriolar end:
Hydrostatic Pressure > Oncotic Pressure =
Fluid passes into the interstitium
Venule end:
Oncotic pressure> Hydrostatic Pressure =
Fluids returns to Capillary Bed
PHYSIOLOGY

4. PATHOPHYSIOLOGY

5. Causes of Edema (1)
PITTING EDEMA NON PITTING EDEMA
● Cardiac cause
○ CCF
○ Pericardial effusion
○ RVH
● Renal Cause
○ Nephrotic Syndrome
○ CKD
● Hepatic Cause
○ Liver cirrhosis
● Hypothyroidism
● Filariasis
● DVT
● Cellulitis

6. Causes of Edema (2)
LOCALISED EDEMA GENERALISED EDEMA (ANASARCA)
● Cellulitis
● Compartment Syndrome
● Lymphedema
● Acute causes
○ allergy
○ vaccine induced
○ drug induced
● Chronic causes
○ renal cause
○ hepatic cause
● Recurrent causes
○ ACE inhibitor induced
angioedema
○ relapse

7. Causes of
Edema
- According to Pathophysiology -

8. Approach to Localised Edema
COMMON CAUSES

10. Approach to Generalised Edema
HISTORY

12. GENERAL PHYSICAL EXAMINATION

13. SYSTEMIC EXAMINATION
1. CARDIAC DISEASE
○ Gallop
○ Tachycardia
○ Tachypnoea
○ Inspiratory crackles
○ Hepatomegaly
2. PERICARDIAL EFFUSION
○ Pericardial Rub
○ Muffled heart sounds
○ Jugular venous distension
3. HEPATIC CAUSE
○ Icterus
○ Hepatosplenomegaly
○ Ascites
4. MALNUTRITION
○ Hepatomegaly

14. INVESTIGATIONS
1. CBC
2. Urine dipstick
3. CXR
4. ECG
5. RFT
6. 24hr Urine Routine & Microscopy
7. LFT

15. TREATMENT
4. Diuretics like Furosemide

18. SUMMARY
● Localized edema is commoner than Generalized
● Commonest cause of edema in children:
a. Generalized: Idiopathic nephrotic syndrome
b. Localized: Allergic reaction
● Most children will have a benign diagnosis and self-limited
course.
● General measures for treatment include management of
primary disease, bed rest, Na+ restriction and Diuretic
administration.
● Most reliable index of progression of treatment of edema is
daily alteration of body weight.