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Abstract: SA-PO710

Dare to Diurese: Lymphedema in a Patient with Spina Bifida

Session Information

Category: Fluid, Electrolytes, and Acid-Base Disorders

  • 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical

Authors

  • Khan, Maheen, LSU Health Shreveport, Shreveport, Louisiana, United States
  • Patel, Neev, LSU Health Shreveport, Shreveport, Louisiana, United States
  • Pethani, Yashvi, LSU Health Shreveport, Shreveport, Louisiana, United States
  • Brigham, Martin, LSU Health Shreveport, Shreveport, Louisiana, United States
  • Sequeira, Adrian P., LSU Health Shreveport, Shreveport, Louisiana, United States
Introduction

Evaluation of edema is a common part of medical practice. While there are myltiple etiologies that can cause edema, diuretics are cornerstone of management and have the potential to be overused. We present one such case in a patient with lymphedema from spina bifida. Patients with spina bifida carry 100 times higher risk of developing primary lymphedema compared to healthy individuals[2]. Lymphedema praecox, the most common form of primary lymphedema, has its onset between age 2 and 35 and has a female to male ratio of 10:1[3].

Case Description

A 28-year-old female with past medical history of spina bifida presented to the ED with worsening lower extremity swelling and light-headedness. Prior evaluation by PCP endocrinologist, and cardiologist were unremarkable.She was on lasix 80 mg twice a day, metolazone 2.5 mg twice a day, spironolactone 50 mg daily and 80 mEq of oral potassium. On arrival, BP was 72/40 mm Hg, pulse 70 per minute, and respiratory rate 40/min. physical exam showed non-pitting edema ib bilateral lower extremities. Labs showed Na 132, K 2.3, Cl 89, Cr 0.8. EKG revealed inverted T waves in anterior leads and prolonged QT interval. Echocardiogram was unremarkable with ejection fraction 55%. Diuretic withdrawal, fluid resuscitation, and potassium replacement corrected her electrolyte and hemodynamic abnormalities. Further evaluation for hypokalemia revealed aldosterone 261 ng/L, renin 100 ng/L, ACTH < 5.0, AM cortisol 3.9, TSH 2.067. Upon evaluation by Nephrology, primary lymphedema was deemed to be the cause of nonpitting edema. Pt was discharged on Lasix 80 mg daily and KCl 40 mEq daily.

Discussion

The case reports highlights a few key points including: 1. recognizition of lymphedema in patients with spina bifida 2. importance of evaluation of peripheral edema and it's causes in all patients 3. cautious use of diuretics and mineralocorticoid receptor agonists especially when used in conjunction 4. frequent monitoring of electrolytes when patients are on diuretics and 5. de-escalation of therapies when edema is refractory to therapy or side effects are frequent.