Causes of Lower Limb Edema: When to Seek Further Medical Advice

Q: Causes of Lower Limb Edema: When to Seek Further Medical Advice

Hello： If the albumin level in the blood is too low, it may also cause lower extremity edema. <br>It is recommended to check the albumin level data, as low levels can lead to lower limb swelling. <br>Thank you for your message!

What are the possible causes of lower extremity edema?

Hello Doctor: My father has been experiencing lower limb edema (with pitting), abdominal bloating, loss of appetite, subjective fatigue (increased sleep duration), along with pain in the skin of both legs and ankle joint pain.
Additionally, his lower limb skin has darkened.
He has visited the emergency department, nephrology, cardiology, hepatobiliary and gastroenterology, and dermatology.
All tests, including blood and urine tests, returned normal results.
They suggested follow-up in outpatient care.
Nephrology recommended a referral to cardiology based on the emergency data, which also showed normal results.
A cardiac ultrasound was performed, ruling out heart failure, and no further referrals were suggested.
The hepatobiliary and gastroenterology department conducted an ultrasound, indicating that the organs were normal.
However, due to the persistence of symptoms and skin pain, he was advised to see dermatology, which again recommended a referral to cardiology.
During this time, the hospital prescribed diuretics, which slightly alleviated the lower limb edema, but it still persists.
Should we consider seeing a cardiologist again, or could there be other underlying causes for the edema?

Jenny, 30~39 year old female. Ask Date: 2023/12/13

Dr. Xie Rongyuan reply Internal Medicine

Hello: If the albumin level in the blood is too low, it may also cause lower extremity edema.
It is recommended to check the albumin level data, as low levels can lead to lower limb swelling.
Thank you for your message!

Reply Date: 2023/12/13

More Info

Lower limb edema, or swelling in the legs, can be a complex issue with various underlying causes. In your father's case, the symptoms of bilateral leg swelling, abdominal bloating, loss of appetite, fatigue, skin pain, and ankle joint pain, combined with the normal results from multiple specialist evaluations, suggest that a thorough investigation is necessary to identify the root cause of his condition.

Edema can result from several factors, including but not limited to:
1. Heart Issues: Congestive heart failure can lead to fluid retention in the lower limbs. Although your father underwent an echocardiogram that ruled out heart failure, it might be worth revisiting this possibility if symptoms persist or worsen. Heart function can sometimes change over time, and further monitoring may be warranted.

2. Kidney Function: The kidneys play a crucial role in fluid balance. If they are not functioning properly, they can lead to fluid retention. Since your father has already seen a nephrologist and had normal lab results, it may be beneficial to continue monitoring kidney function, especially if symptoms persist.

3. Liver Disease: Liver dysfunction can lead to fluid accumulation in the abdomen (ascites) and lower limbs. Although the ultrasound showed normal liver function, it may be worth discussing with a gastroenterologist if there are any subtle signs of liver disease that could have been missed.

4. Venous Insufficiency: This condition occurs when the veins cannot pump enough blood back to the heart, leading to swelling in the legs. A vascular specialist can perform tests to evaluate the venous system and determine if this is a contributing factor.

5. Medication Side Effects: Certain medications, including diuretics, can cause electrolyte imbalances or lead to rebound fluid retention. If your father has been prescribed diuretics, it may be worth discussing with his physician whether adjustments are needed.

6. Infection or Inflammation: Conditions such as cellulitis or deep vein thrombosis (DVT) can also cause swelling. If there are signs of redness, warmth, or increased pain in the legs, immediate medical attention is necessary.

7. Nutritional Factors: Malnutrition or low protein levels can lead to edema. A dietitian can assess his nutritional intake and recommend dietary changes if necessary.

Given the complexity of your father's symptoms and the fact that he has seen multiple specialists without a definitive diagnosis, it may be prudent to seek a comprehensive evaluation from a primary care physician or a geriatric specialist who can coordinate care among the various specialties. They can help determine if further testing is needed, such as blood tests for protein levels, additional imaging studies, or referrals to other specialists.

In summary, while your father's symptoms have been evaluated by several specialists, the persistence of edema and associated symptoms warrants further investigation. It is advisable to continue seeking medical advice, particularly from a primary care physician who can provide a holistic view of his health and coordinate further evaluations.

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