Edema Management

Initial Treatment

The initial treatment for edema should include moderate sodium restriction (2 g or 90 mmol/day) and diuretic therapy, with loop diuretics (furosemide) as first-line treatment for most types of edema, as recommended by the Hepatology society 1
Spironolactone can be used as add-on therapy when loop diuretics alone are insufficient, particularly in patients with heart failure, cirrhosis with ascites, or as add-on therapy when loop diuretics alone are insufficient, according to the Hepatology society 1

Loop diuretic (furosemide 40 mg/day) is recommended as the initial approach for edema management, as suggested by the Hepatology society 1
Spironolactone (100 mg/day) with or without furosemide is recommended as first-line therapy for cirrhotic patients with ascites, according to the Hepatology society 1
For tense ascites, large-volume paracentesis combined with albumin, followed by diuretic therapy, is recommended, as suggested by the Hepatology society 1

Regular monitoring of body weight, serum creatinine, and electrolytes (especially sodium and potassium) is essential, as recommended by the Hepatology society 1
Dose adjustment is necessary after edema is adequately mobilized, and diuretics should be tapered to the lowest effective dose to maintain minimal or no edema, according to the Hepatology society 1
Fluid restriction is not necessary unless there is concomitant moderate or severe hyponatremia (serum sodium ≤125 mmol/L), as suggested by the Hepatology society 1

In patients with chronic kidney disease, higher doses of loop diuretics and lower doses of aldosterone antagonists are typically needed, as recommended by the Hepatology society 1
Avoid fluid overload in patients with generalized peritonitis as it may aggravate gut edema and increase intra-abdominal pressure, according to the World Journal of Emergency Surgery society 5
For increased intracranial pressure (ICP), mannitol 0.25-0.5 g/kg IV over 20 minutes, can be given every 6 hours (max 2 g/kg), as suggested by the Circulation society 3

Hypokalemia may occur with loop diuretics, and consideration should be given to adding spironolactone or potassium supplements, as recommended by the Hepatology society 1
Hyperkalemia is a risk with spironolactone, and the dose should be reduced or switched to alternate-day dosing if serum potassium >5.0 mEq/L, according to the Hepatology society 1
Correcting electrolyte abnormalities (hypokalemia, hypomagnesemia) and considering baclofen (10 mg/day, with weekly increase up to 30 mg/day) or albumin administration (20-40 g/week) may help in managing edema, as suggested by the Hepatology society 1