Edema

When salt (and water) are retained, the result is edema, which means swelling of the soft tissues from fluid. The fluid accumulates by gravity in the lowest part of the body; at night, this means the back, where it is seldom noticed. In the daytime it appears in the ankles and feet most noticeably, particularly at the end of the day. It is detected by pressing the body with a finger or thumb for a few seconds and then releasing; a dent remains. This is called "pitting edema." Other parts of the body may swell, too. For example, some patients (women in particular, I think) notice swelling of the abdomen even when there is no pitting edema. When fluid accumulates within the air spaces of the lungs (pulmonary edema), exchanges of oxygen and carbon dioxide are impaired; as a result, the heart may fail. Pulmonary edema is a medical emergency.

Although edema is rather uncomfortable, in itself it is not serious unless it occurs in the lungs. A small amount of edema may in fact be desirable in many patients, because when they take diuretics to remove the excess fluid, their blood pressure falls too far. The problem is that the associated increase in the volume of body fluids often aggravates hypertension and/or congestive heart failure in patients suffering from these complications. Both of these conditions are acutely sensitive to the volume of the extracellular fluids.

Treatment of edema is usually straightforward, except in the nephrotic syndrome. (See Chapter 18.) Restriction of salt intake plus administration of diuretic drugs generally does the trick. That said, it is foolish to give diuretic drugs without some attempt to restrict salt intake, because doing so would be self-defeating. However, severe salt restriction is not advisable because it is so unpalatable. In order to limit salt intake moderately, simply refrain from adding salt to food during cooking and at the table. Also avoid prepared foods high in sodium, as indicated by nutrition labels.

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