Oedema

There are many causes of peripheral oedema which may present during terminal illness and each cause will have a slightly different treatment approach accordingly.  

Causes

• Organ failure (heart, liver, kidney)
• Low albumin either due to disease process or nutrition depletion
• Immobility - following a stroke may affect one side or one limb disproportionately 
• Venous insufficiency
• Primary congenital or familial lymphoedema will have been present prior to diagnosis
• Secondary to obstruction from a tumour, especially pelvic and breast tumours
• Secondary to radiotherapy or lymph node clearance

Non-drug treatment

• High quality skin care and avoidance of infections/ulcers
• Compression - either via massage or hosiery
• Exercise

Drug treatments

• Diuretics will be beneficial in certain cases and choice of loop versus potassium sparing will depend on disease process
• Corticosteroids may be beneficial for obstructive tumours but may also increase fluid retention
• Proactive treatment of infections following up to date antimicrobial guidance for cellulitis
• Analgesia