Fluid Overload: Symptoms, Causes & Management

Hypervolemia: When the Body Holds Too Much Fluid

Fluid overload (hypervolemia) occurs when total body sodium and water exceed physiological needs, expanding extracellular volume.

Common Causes

• Excessive intake – IV fluids, polydipsia, tube feeding.
• Renal failure – Impaired sodium/water excretion.
• Heart failure – Reduced cardiac output → renal hypoperfusion → RAAS activation → salt/water retention.
• Liver cirrhosis – Low albumin → decreased oncotic pressure → third‑spacing (ascites, edema).
• Medications – Corticosteroids, NSAIDs, gabapentin, TZDs.

Clinical Manifestations

• Peripheral edema (ankles, sacrum), rapid weight gain.
• Pulmonary edema – dyspnea, orthopnea, crackles, hypoxia.
• Elevated JVP, S3 gallop, hepatomegaly.
• Hypertension, headache, confusion (cerebral edema).

Management Principles

1. Restrict sodium & fluid (e.g., <2 g Na⁺/day, 1.5–2 L fluid).
2. Diuretics – Loop diuretics (furosemide) first‑line; add thiazide if resistant.
3. Treat underlying cause – Optimize HF meds, dialysis for ESRD, paracentesis for tense ascites.
4. Monitor – Daily weights, I/O, electrolytes, renal function.

Acute pulmonary edema is a medical emergency requiring oxygen, non‑invasive ventilation, IV diuretics, and afterload reduction.