Orthostatic Edema in Adolescents: More Than Walking on Water

Abstract

1. Robert M. Cavanaugh Jr, MD* 1. *Associate Professor and Director of Adolescent Medicine, Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY After completing this article, readers should be able to: 1. List the variety of presentations of orthostatic edema. 2. Describe the symptoms of orthostatic edema. 3. Recognize and treat orthostatic edema in adolescents. Idiopathic edema is the abnormal retention of fluid that, after a thorough clinical examination and laboratory investigation, has been found to have no known cause. Orthostatic edema, the most common form of idiopathic edema, is a generalized systemic disorder that has a wide variety of presentations and many associated symptoms. Weight gain typically occurs throughout the day, with excessive increments from morning to evening. The edema is most evident in the legs, feet, or abdomen after prolonged sitting or standing, but may occur in other areas. The findings often are subtle, and a high index of suspicion is required. The purpose of this article is to heighten awareness among practitioners of the occurrence of orthostatic edema in adolescents and to provide guidelines for diagnosis and treatment. ### Case 1 A 12-year-old girl was evaluated in an adolescent medicine consultation setting for a 10-month history of swelling in both lower extremities. The swelling started in both feet shortly after menarche and gradually extended up to the knees. It was progressively worse toward the end of each day. The patient also had nocturnal enuresis. Results of the following laboratory studies were within normal limits: complete blood count, erythrocyte sedimentation rate, electrolytes, serum albumin and total protein, liver enzymes, serum thyroxine and thyroid-stimulating hormone, urinalysis, antinuclear antibody, rheumatoid factor, C3 and C4 complement, creatine kinase, C1 esterase inhibitor level (qualitative and quantitative), and chest radiography. She was not in heart failure. No evidence of lymphedema praecox or other lymphatic abnormality was detected when lymphoscintigraphy was performed. Orthostatic edema was diagnosed, and treatment with ephedrine 25 mg orally in the morning was initiated. The swelling and enuresis …