Limb edema

Imatinib is relatively well tolerated, but it has some significant adverse effects. Some of the most common side effects include nausea, vomiting, diarrhea, edema, muscle cramps, and rash. The edema is usually characterized by periorbital swelling or lower limb edema but may manifest as pleural effusions, ascites, and pulmonary edema. The fluid retention is often managed with dose reduction, diuretics and other supportive care measures. Imatinib also may be associated with cytopenias (primarily neutropenia and thrombocytopenia). These effects are thought to be dose related and are more common in patients with accelerated phase or blast crisis compared with chronic phase CML. Dose reduction or interruption in imatinib therapy may be considered to manage the cytopenias. 

Aliskiren has also been shown to be associated with fewer cases of severe lower limb edema when combined with amlodipine compared with amlodipine alone [9 ]. It seems prudent that patients who develop calcium channel blocker-induced peripheral edema should receive a renin-angiotensin system inhibitor as part of rational combination therapy, rather than withdrawing the former, unless patients are already at their target blood pressure and combination treatment may lead to overtreatment [Iff]. 

E. Keleman, J.IvAnyi and M.Majoros, Hyaluronidase Limb-Edema Test on Rat (A Technique for Investigation on Permeability), Acta med. hung. 2, 201—204 (1951). 

Clinically, a limb edema is the result of swelling from excessive accumulation of serous fluid in tissue. It depends on two factors. First, excessive liquid is generated in the interstitial space due to obstructive venous diseases presenting as varicose veins or postthrombotic syndrome, heart or kidney failure, metabolic deficits with altered and low protein concentration in the blood, or many other conditions. Second, a lymphatic drainage deficit due to alteration of the lymphatic system can result in water and protein stagnation. Lymphedema frequently occurs in many upper- and lower-limb pathologies. 

After intraamniotic injection, acrolein is teratogenic to rats in vivo but not in vitro. When administered intraamniotically to the whole embryo culture system of the rat on day 13 of gestation, acrolein caused edema, hydrocephaly, open eyes, cleft palate, abnormal umbilical cord, and defects of the limbs and face (Slott and Hales 1986). Beauchamp etal. (1985) suggest that acrolein-associated teratogenicity is caused by acrylic acid, an acrolein metabolite. Acrylic acid injected into amniotic fluid of rats on day 13 of gestation produced a dose-dependent increase in the percent of fetuses with skeletal and other abnormalities (Beauchamp et al. 1985). 

Intraamniotic injection route. Embryos given 0.1, 1, 10, or 100 pg of acrolein on day 13 of gestation examined on day 20 of gestation Intraperitoneal injection route 98-100% dead at 10 and 100 pg 85% of live fetuses receiving 1 pg were malformed (edema, hydrocephaly, cleft palate, defects of limbs and tail) no teratogenic effects at 0.1 pg 6... 

Increased appetite, weight gain, headache, loss of libido, edema of face and limbs, nausea, alopecia, dry skin, rash, hypothyroidism... 

Furosemide Loop diuretic Decreases NaCI and KCI reabsorption in thick ascending limb of the loop of Henle in the nephron (see Chapter 15) Increased excretion of salt and water reduces cardiac preload and afterload reduces pulmonary and peripheral edema Acute and chronic heart failure severe hypertension edematous conditions Oral and IV duration 2-4 h Toxicity Hypovolemia, hypokalemia, orthostatic hypotension, ototoxicity, sulfonamide allergy... 

Na/K/2CI transporter in the ascending limb of Henle s loop excretion, some wasting, hypokalemic metabolic alkalosis, increased urine Ca and Mg peripheral edema, hypertension, acute hypercalcemia or hyperkalemia, acute renal failure, anion overdose duration of action 2-4 h Toxicitiy Ototoxicity, hypovolemia, wasting, hyperuricemia, hypomagnesemia... 

Secondary symptoms Heaviness of the limbs, sallow complexion, prolapse of the internal organs (e.g. uterus, stomach and rectum), large amount of leukorrhea, edema, heavy menstruation, poor concentration or inability to study and memorize things. 

Low vitality, cold limbs and a cold sensation of the back, edema, poor concentration, forgetfulness, irregular menstruation and dysmenorrhea. 

Edema, cough with thin, watery phlegm, hydrothorax, ascites, diarrhea, difficult urination or retention of urine, painful, swollen, heavy and cold limbs, fear of cold. 

Sang Zhi is bitter and neutral, and enters the Liver meridian. It is the twig of the plant, and can open the meridians and expel wind and dampness. It is particularly selected when edema and cramp of the limbs are present. 

A healthy 19-year-old woman complained of nausea and vomited 8 hours after taking unknown quantities of MDMA and beer 3 hours later, she suddenly clenched her jaw, had tonic contractions of all four limbs, and collapsed. She was obtunded, with occasional moaning and non-purposeful movements of the limbs. Head CT scan showed mild cerebral edema. Her serum electrolytes, including a sodium of 115 mmol/1 and a corresponding urine osmolality of 522 mosm/kg, suggested SIADH. Despite treatment, the serum sodium concentration 10 hours later was 116 mmol/1, but 18 hours after treatment, it rose to 125 mmol/1. She became progressively more responsive, with normalization of her sodium concentration, and after 48 hours was awake and alert, with a serum sodium concentration of 136 mmol/1. 

In 17 of 53 cases with obstructive lymphedema there was an increase in Umb volume after lymphangiography with Lipiodol ultrafluid (iodinated poppy seed oil), and 10 cases had features resembling Ijmphangitis. In one patient there was an allergic reaction, with rapid development of edema and an increase in limb volume by 2 liters. Whereas contrast medium virtually disappears from normal Ijmphatics within 8 hours, in cases of obstructive lymphedema Lipiodol remains in the lymphatics for several days and it appears to cause a low grade chemical inflammation with obliteration of the lymphatics (SEDA-7, 454). 

From a case in which there was positive dechallenge and rechallenge it has been concluded that edema of the lower limbs can be an adverse effect of ritonavir in some HIV-positive patients (11). The authors suspected a relation to the drug s vasodilatory activity. However, it should also be borne in mind that ritonavir has caused reversible renal insufficiency, which should be looked for in any patient who develops edematous changes. 

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