Excess Volume - Causes and Treatment

What Is Hypervolemia or Excessive Volume?

The human body requires fluids and electrolytes in large amounts to remain healthy and carry out important procedures. Water and electrolytes are the most important fluids required by the body. The brain, kidneys, and adrenal glands are the three most important organs that regulate the body's fluid levels. The body uses these fluids to make chemical substances that help the cells to carry out their functions.

However, some of these chemicals and fluids are not required by the body and are in excess. The kidneys' job is to take up these excess fluids from the blood, convert them into the urine, and excrete them. This is how the fluid levels in the body are regulated. The problem arises when the kidneys cannot carry out their activities properly. As a result, the fluids keep on accumulating in the body resulting in a condition known as hypervolemia. Mild hypervolemia occurs due to sodium accumulation and subsides after some time. However, treatment is required when the condition becomes severe.

What Are the Causes of Volume Excess?

Hypervolemia occurs when the person consumes too much salt (sodium), and the body retains excess fluids. The causes of volume excess or hypervolemia have been described below:

1. Heart Failure - Heart failure is a condition in which the heart cannot pump blood to the body’s organs. The muscles become stiff, making it difficult for the heart to supply blood. As a result, the kidneys do not receive sufficient blood and fail to function, resulting in fluid retention in the body.

2. Liver Cirrhosis - Cirrhosis of the liver is a disease in which the scar tissue replaces the healthy liver tissues resulting in liver damage. When the liver is damaged, it is unable to store the nutrients and filter the waste products that cause fluid accumulation in the abdominal region. The presence of excessive fluids in the abdomen is known as ascites.

3. Kidney Failure - The kidneys are a crucial organ of the urogenital tract. They work to filter the blood and remove the excess fluids and toxins from the body. When the kidneys are damaged or have failed to work, the electrolytes like sodium, potassium, and calcium accumulate in the body, causing hypervolemia.

4. Head Injury - One of the most common causes of hypervolemia is head injury. The brain might get damaged due to head injury, resulting in a disturbance in the body's fluid levels. It is because the brain gives signals to the kidneys when the fluids are in excess; when the brain is not working properly due to trauma, the risk of hypervolemia increases.

5. Hormonal Imbalance - An antidiuretic hormone, aldosterone, and atrial natriuretic peptide hormones regulate the body's fluid levels. Pregnancy and premenstrual syndrome cause disturbance of the levels of these hormones resulting in the retention of too many fluids in the body.

6. Excessive Salt Intake - If salty food items are consumed excessively, the risk of hypervolemia increases. It is because the sodium levels are raised, resulting in excess water retention in the body. Young children and old age people should not consume salts in excess to avoid hypervolemia.

7. Medications - Certain medications like hormone replacement and birth control pills increase the body's fluid levels. Females consuming these medications for a prolonged period are likely to develop hypervolemia.

8. Intravenous Fluids - Intravenous (IV) fluids are injected into the body through the veins after surgery or to treat dehydration. They contain salt (sodium) and water and help replenish the body's fluid levels. The problem arises when these fluids are given in excess. It is because the body retains them for a prolonged period, leading to hypervolemia.

9. Malnutrition - Malnutrition is a condition wherein the body does not get enough nutrients, minerals, and vitamins. As a result, the vital body organs fail to work, and the fluid and electrolyte levels of the body are disturbed.

10. Nephrotic Syndrome -The kidneys contain thousands of tiny units known as nephrons. They remove the toxins from the blood and form urine. The nephrotic syndrome makes it difficult for the nephrons to work properly. As a result, the fluids remain in the body, resulting in hypervolemia.

What Are the Signs and Symptoms of Hypervolemia?

The symptoms of hypervolemia depend upon the location where the fluid is present in excess and the underlying condition. The signs and symptoms of hypervolemia or excessive fluid volume are listed below:

• Swelling - Edema or swelling of the arms, legs, face, and hands occurs when the fluid gets deposited in these body parts. If an indentation occurs when the patient presses the swelling, it is known as pitting edema.

• Respiratory Difficulties - The patient might experience shortness of breath if the fluid gets deposited in the lungs. A crackling sound is heard when the person breathes.

• Hypertension - Hypertension or high blood pressure occurs when the heart fails to function. As a result, the blood flows under high pressure throughout the body.

• Weight Gain - The patient gains weight rapidly due to the accumulation of fluids in the body.

• General Problems - Headache, restlessness, anxiety, and stomach bloating make it difficult for the patient to focus on his daily activities.

• Chest Pain - Pain in the chest occurs when the lungs swell due to the deposition of excess fluid.

What Tests Are Done to Diagnose Excess Fluid Volumes of the Body?

The diagnosis of hypervolemia, or excess bodily fluids, is based on medical history, physical examination, laboratory tests, and imaging tests.

1. Physical Examination - The doctor examines the patient to check the body weight, blood pressure, heart rate, respiratory rate, and swelling of the body parts due to fluid accumulation. The swelling over the abdomen is also checked to rule out ascites.

2. Laboratory Tests - The following laboratory tests are recommended to check the levels of fluids and electrolytes in the body:

   1. Blood Tests - The doctor recommends the patient undergo a blood test to check the levels of sodium in the body. The sodium, creatinine, and urea levels are generally high in hypervolemia. Creatinine is a waste product formed due to muscle activity, and urea is formed after the breakdown of amino acids. The hemoglobin and hematocrit levels are also very low in such patients.

   2. Urinalysis - The patient is asked to collect urine in a sterile bag provided by the hospital. It is then sent to the laboratory for examination under the microscope. Hypervolemia can be suspected if the test reports indicate reduced urine output and increased sodium levels.

   3. Imaging Test - Imaging tests like X-ray are used to check the condition of the lungs. The X-ray machine is located near the patient's chest to obtain the images. A chest X-ray is taken to check the fluid accumulation in the lungs. A cloudy white appearance is seen on the X-rays due to fluid accumulation.

How Is Hypervolemia Managed?

The treatment of hypervolemia depends upon the causes and the severity of the condition. The treatment options have been described below:

• Medications - Mild hyperkalemia can be treated with antibiotics. The medications and their uses have been described in the table below:

• Dialysis - Dialysis is an artificial kidney machine that helps to filter blood. If the patients are suffering from kidney failure or chronic kidney disease, the excess fluids and electrolytes are removed from the body with the help of dialysis.

• Paracentesis - Paracentesis is a procedure in which excess fluid is removed from the abdomen. A tube attached to a needle is inserted into the abdomen to remove the fluid. The fluid can be discarded or sent to the laboratory to check for infection or ascites.

• Lifestyle Changes - The following changes in the lifestyle help to maintain an optimum fluid balance of the body:

  • Salt intake should be restricted.

  • Quit smoking immediately.

  • Maintain healthy body weight.

  • Keep a record of the fluids consumed daily.

  • Avoid drinking alcohol.

  • Tea and coffee should not be consumed excessively as they contain caffeine.

  • Go for a walk and exercise regularly.

  • Maintain a healthy sleep cycle.

  • Stay calm and do not be stressed every time.

  • Blood pressure and glucose levels should be monitored regularly.

What Are the Complications of Hypervolemia?

If the condition is left untreated for a long time, the fluids accumulate in different body organs and damage them. The complications of hypervolemia are listed below:

1. The fluids accumulate in the air sacs in the lungs resulting in pulmonary edema. Chest pain and breathing difficulties are commonly seen due to pulmonary edema.

2. The fluid gets deposited in the membranes of the heart resulting in swelling and inflammation. As a result, the heart fails to function and does not pump blood to the organs.

3. Excess bodily fluids interfere with the healing process, so the wounds take a long time to heal.

4. If the fluids get deposited in the intestines and the abdomen, constipation occurs due to reduced bowel movement.

Conclusion:

Hypervolemia is a condition in which the fluids and electrolytes are present in the body in excess. Several causes of hyperkalemia include increased sodium consumption, pregnancy, kidney failure, and liver cirrhosis. Some medications help to stimulate the kidneys to form urine and remove the excess fluids from the body. Patients with kidney failure can undergo dialysis or paracentesis to remove the fluids. The success of the treatment depends on how early the condition has been diagnosed. Therefore, the patient must restrict salt intake, maintain a healthy weight, and consult the doctor at the earliest to avoid complications.