Hypervolemia: The Daily PANCE Blueprint

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Hypervolemia: The Daily PANCE Blueprint

A 60-year-old male with a history of congestive heart failure and chronic kidney disease presents to the ER complaining of shortness of breath and worsening bilateral leg swelling. Vitals are unremarkable except he is hypoxemic (SpO2 88%). On physical exam he has 2+ pitting edema on bilateral lower extremities, diminished lung sounds in lower lung bases, and elevated JVD. Labs are significant for elevated BNP. CXR revealed bilateral pleural effusions and bilateral interstitial opacities. Which of the following is the most likely diagnosis?

A. Volume overload / pulmonary edema
B. Septic shock with organ dysfunction
C. Atypical pneumonia
D. Decompensated heart failure
E. Both A and D

Answer and topic summary

The answer is E. Both A and D

Fluid overload state or hypervolemia is a condition defined by too much fluid in the body. It can be due to conditions (liver failure, CHF, kidney failure) or iatrogenic (too much IV solutions or blood transfusions). The pathophysiology differs between these etiologies. Signs of volume overload include pleural effusions, interstitial or alveolar edema, cardiomegaly, elevated BNP, dilated IVC diameter, pitting edema, weight gain, JVD, elevated CVP, and possibly hyponatremia. Management may include diuretics, sodium and fluid restriction, dialysis, or procedures to remove fluid (e.g., thoracentesis or paracentesis).

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Renal System ⇒ Fluid and Electrolyte Disorders ⇒ Hypervolemia

Also on the PAEA EOR rotation blueprint for Internal Medicine

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