Pediatric emergency medicine trisk 140

TABLE 25.1
CAUSES OF EDEMA


Decreased oncotic pressure
Protein loss
Protein-losing enteropathy
Nephrotic syndrome
Reduced albumin synthesis
Liver disease
Malnutrition
Increased hydrostatic pressure
Increased blood volume from water and sodium retention
Congestive heart failure
Primary renal sodium retention
Acute glomerulonephritis
Henoch–Schönlein purpura
Nephrotic syndrome
Renal failure
Premenstrual edema or edema of pregnancy
Venous obstruction
Constrictive pericarditis
Acute pulmonary edema
Portal hypertension
Budd–Chiari syndrome
Local venous obstruction
Thrombophlebitis/deep venous thrombosis
Increased capillary permeability
Allergic reaction
Hereditary angioedema
Inflammatory reactions

Burns
Cellulitis
Sepsis


Pit viper envenomation
Vasculitis
Lymphatic dysfunction/other
Hypothyroidism (myxedema)
Lymphedema
Milroy disease
Meige disease (lymphedema praecox)
Turner syndrome
Noonan syndrome
Epstein–Barr virus infectious mononucleosis (upper eyelid edema)
TABLE 25.2
COMMON CAUSES OF EDEMA
Localized
Allergic reaction
Cellulitis
Trauma
Generalized
Nephrotic syndrome
Allergic reaction


TABLE 25.3
LIFE-THREATENING CAUSES OF EDEMA
Localized
Allergic reaction with airway involvement

Medication induced angioedema
Hereditary angioedema
Cellulitis (with bacteremia)
Pit viper envenomation
Superior vena cava syndrome
Venous thrombosis
Cerebral edema
Reexpansion pulmonary edema
Generalized
Cardiac disease
Congestive heart failure
Pericardial effusion
Hepatic failure
Renal disease
Nephrosis
Nephritis
Sepsis
Localized bilateral upper eyelid edema (Hoagland sign) may be found in up to
50% of patients with Epstein–Barr virus (EBV) infectious mononucleosis. It is
not associated with any significant discomfort, is seen only for the first few days
of the illness, and is very specific for EBV so that it may be used to trigger further
laboratory evaluation to confirm the diagnosis.
When a child presents with severe or recurrent facial edema, especially if there
is a family history of similar symptoms, the diagnosis of hereditary angioedema
(see Chapter 85 Allergic Emergencies ) should be considered. When a patient
with localized edema of the head or neck presents for care, it is crucial that the
physician evaluate the child carefully for concurrent airway involvement. Facial
edema may also be caused by oral, dental, or sinus infections, including acute