Ask Dr. Atef about Swelling

I have noticed swelling in my ankles. The swelling has been there for a few weeks. I am concerned about it. Do you have any advise? Swelling in feet, ankles and lower part of legs is due to leakage of fluid from the vasculature in the soft tissues around the vessels. Fluid makes about %60 of our body weight. It is important to know that this fluid is all placed in different compartments. Two third of this fluid in placed in the cells. The rest of this fluid is outside the cells. These two fluids have different constituents. From the one third which is outside the cell, one fourth of it is in blood vessels and the rest (three fourth of the fluid which is outside the cells) is distributed between the different tissues of the body (the fluid between the cells).

Just for the sake of better understanding imagine if somebody is 160 pounds (lbs). This person will have about 96 lbs of fluid in the body. From this 96 lbs, about 64.3 is inside the cells, 21.2 lbs are between the cells and 10.5 lbs are in the vessels.

Under different conditions the amount of fluid which resides in the area between the cells (interstitial fluid) increases. This excessive amount of fluid in the areas between the cells is called edema.

Edema moves with gravity. This is why if somebody develops edema, this fluid tends to accumulate in the lower part of the body (ankles and legs). And if the person lies flat, this fluid tends to move away from the legs.

This is a simplified way of understanding edematous state.

Now in our example person, when he or she develops edema his or her weight increases. In this case the person’s weight can increase to about 175 lbs or more.

This excessive fluid will show itself mostly in interstitial area and is called edema.

Edematous status requires further work up.

This information is important for patients who have edema (such as in patients with heart failure, kidney failure or liver disease) and take water pills (diuretic).

I will post more info on that on my near future blog posts.

Dr. Atef (Dallas)

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