Hypervolaemia

Hypervolaemia occurs when your body holds onto too much fluid. This excess can cause swelling, breathing difficulties, and potentially serious heart problems. Understanding the causes and knowing how to manage this condition can help protect your health.

Fluid overload, Volume overload

Table of contents

• What is hypervolaemia?
• Who does hypervolaemia affect?
• Understanding body fluids
• Signs and symptoms
• What causes hypervolaemia?
• How is hypervolaemia diagnosed?
• Treatment options
• Prevention and lifestyle changes
• Possible complications

What is hypervolaemia?

Hypervolaemia is a medical condition where your body has too much fluid. The term comes from “hyper,” meaning too much, and “vol,” referring to volume^[1]. When you have hypervolaemia, excess fluid builds up in various parts of your body, including your blood vessels and the spaces around your cells^[2].

Your body normally maintains a careful balance of fluids. When this balance is disrupted and too much fluid accumulates, it can cause discomfort and potentially serious health problems^[3]. While mild cases may resolve on their own, more severe hypervolaemia requires medical attention and treatment.

Who does hypervolaemia affect?

Hypervolaemia can affect anyone, but certain groups of people are at higher risk^[1]. People with heart or kidney conditions commonly experience this problem because these organs play key roles in managing fluid balance in the body^[2].

Pregnant women often experience fluid retention, especially swelling in the legs or ankles, because the growing uterus puts pressure on blood vessels^[1]. Women may also notice mild fluid retention during their menstrual cycle due to hormonal changes^[3].

People who consume too much salt in their diet are also at risk, as are those receiving intravenous fluids in hospital settings^[3]. The exact rate of occurrence is unknown because mild cases often resolve on their own, while severe cases are usually a symptom of an underlying health condition^[1].

Understanding body fluids

Your body is made up of 50% to 60% fluid, which includes water, blood, and lymphatic fluid (a clear fluid that carries immune cells throughout the body)^[1]. These fluids are essential for keeping your organs functioning properly, especially by moving blood through your circulatory system (the network of blood vessels that carries blood throughout your body)^[1].

When functioning normally, your body carefully manages the amount of fluid you have by balancing what you take in with what you lose through urination, sweating, and breathing^[2]. Your kidneys play a particularly important role in this process by removing excess fluid and balancing the amount of salt in your body^[7].

Signs and symptoms

The symptoms of hypervolaemia can range from mild to severe, depending on how much excess fluid has accumulated and how quickly it built up^[1]. In mild cases, you may not notice any symptoms at all, or the symptoms may be easy to dismiss^[7].

Common mild to moderate symptoms include:

• Swelling in your arms, legs, ankles, feet, or face, where the area appears larger than it did the day before^[1]
• Bloating in your stomach or abdomen^[1]
• Rapid weight gain, which is caused by fluid rather than increased body fat^[6]
• Mild discomfort such as cramping or headache^[1]
• Feeling tired or weak^[6]

Severe symptoms that require immediate medical attention include:

• High blood pressure caused by excess fluid in the bloodstream^[1]
• Shortness of breath or difficulty breathing, especially when lying down, which occurs when extra fluid enters your lungs^[1]
• Heart problems, including irregular heartbeat or heart failure (a condition where the heart cannot pump blood as effectively as it should)^[1]
• Chest pain, which can be a sign of fluid in the lungs^[3]

If you experience any serious symptoms, visit the emergency room immediately^[1].

What causes hypervolaemia?

Several factors can cause hypervolaemia, but they usually involve problems with how your body manages salt and water^[2]. In most cases, multiple factors contribute to the condition^[1].

Too much sodium (salt)

The most common cause of hypervolaemia is too much salt in your body^[2]. Salt is an essential mineral that your body manages with water. When you eat food containing too much sodium, your body uses water to balance it back to normal levels, which is why you might feel thirsty after eating salty foods^[1].

If you receive intravenous fluids after surgery or when dehydrated, some of these fluids contain sodium. It’s possible to experience symptoms of hypervolaemia while getting IV fluids because your body’s sodium levels become unbalanced^[1].

Heart conditions

Congestive heart failure is a condition where the heart cannot pump enough blood to meet the body’s needs^[2]. When the heart’s blood pumping ability decreases, the kidneys cannot work as they should, which leads to an excess of fluid in the body^[2]. Hypervolaemia is common in people with chronic heart failure, and for some, it never goes away completely even with treatment^[2].

Kidney problems

The kidneys help regulate the amount of sodium and fluid in the body, so people with kidney problems are at significant risk of hypervolaemia^[2]. When kidneys are damaged or not functioning properly, they struggle to remove excess fluid and sodium, allowing fluid to build up in the body^[6]. Hypervolaemia is especially common in patients on dialysis or in later stages of kidney disease^[5].

Liver disease

Hypervolaemia may occur when the liver cannot properly store and process nutrients and filter toxins^[2]. Liver problems, particularly cirrhosis (scarring of the liver), tend to cause fluid retention in the abdominal area and the extremities^[2]. Fluid accumulation in the abdomen, known as ascites, is the most common complication of cirrhosis of the liver^[2].

Hormonal changes

Changes to your hormones can cause hypervolaemia, most often during your menstrual period or during pregnancy when your body retains more sodium and water^[1]. These cases are usually mild and temporary^[2].

Certain medications

Some medications can cause fluid retention as a side effect, especially drugs used to treat blood pressure or pain^[1]. These include corticosteroids and nonsteroidal anti-inflammatory drugs^[4].

How is hypervolaemia diagnosed?

To diagnose hypervolaemia, your healthcare provider will review your symptoms and medical history, and perform several tests^[6].

The physical examination may reveal signs of fluid overload, such as swelling, increased pressure in the veins of your neck, or abnormal sounds when listening to your lungs^[16]. Your doctor will also check your blood pressure and weight^[6].

Blood tests may be performed to assess kidney function, check levels of salt and other minerals in your blood, and evaluate markers of heart function^[16]. Urine tests can help evaluate how well your kidneys are excreting fluid^[6].

Imaging tests, such as chest X-rays or ultrasounds, may be conducted to identify fluid buildup in the lungs or abdomen^[6]. Regular weight monitoring is also important, as rapid weight gain is often the first sign of fluid overload^[3]. Most people gain 8 to 15 pounds before they notice swelling in their legs or abdomen^[3].

Treatment options

Treatment for hypervolaemia focuses on removing excess fluid from your body and addressing the underlying cause^[6]. The aggressiveness of therapy depends on how quickly the condition developed, the absolute level of fluid overload, and the severity of symptoms^[8].

Medications

Diuretics, also known as “water pills,” are medications that help your body remove excess sodium and fluid through urine^[6]. These are the primary treatment for hypervolaemia. Commonly used diuretics include furosemide and spironolactone^[6]. Your healthcare provider will monitor your response and adjust the dose as needed.

Dialysis

For patients with advanced kidney disease, dialysis may be required to remove fluid that the kidneys can no longer filter^[6]. Dialysis uses a special machine to filter excess fluid and waste products from the blood^[1]. It can also be used in emergency situations when fluid overload becomes life-threatening^[6].

Treating the underlying cause

Addressing the condition that caused hypervolaemia is essential to prevent it from recurring^[1]. This might involve managing heart failure, adjusting medications, or addressing liver disease^[6]. All sources of extra salt should be immediately discontinued, including intravenous and oral salt supplementation^[4].

Prevention and lifestyle changes

Several lifestyle changes can help prevent hypervolaemia or reduce its severity^[6].

Limit sodium intake

Reducing the amount of salt in your diet is one of the most important steps you can take^[6]. Avoid high-sodium foods like canned soups, deli meats, and salty snacks. Use salt-free seasonings or herbs to flavor meals instead^[6]. Be aware that most salt substitutes contain potassium and should only be used if approved by your doctor^[1].

Monitor fluid intake

If your doctor recommends limiting fluids, keep track of how much you drink each day^[17]. To manage thirst, try sucking on ice chips, sugar-free candy, or frozen fruit like grapes^[17]. If you have kidney, heart, or liver disease and need to limit fluids, talk with your doctor before changing the amount of fluids you drink^[1].

Watch your weight

Daily weight checks help detect subtle changes that could indicate fluid buildup^[6]. Weigh yourself at the same time each day, preferably in the morning after urinating and before eating. Alert your healthcare team if you notice sudden weight increases accompanied by swelling or other symptoms^[6].

Elevate swollen areas

If your symptoms are mild, you can elevate the swollen part of your body while you rest, like putting your swollen ankle on a pillow while lying down^[1]. Wearing compression stockings may also help^[1].

Follow your treatment plan

For patients on dialysis, it is crucial to complete your full treatment sessions as scheduled and follow all fluid and dietary restrictions between treatments^[17]. Take your medicines exactly as prescribed, and call your doctor if you think you are having a problem with your medicine^[1].

Possible complications

If left untreated, hypervolaemia can lead to serious complications^[8]. The most common result of fluid overload is congestive heart failure^[4]. Excess fluid can speed up or slow your heart rate, harm your heart muscles, and increase the size of your heart^[7].

Fluid overload can also cause problems with wound healing and bowel problems^[2]. When fluid enters the lungs, it creates a condition called pulmonary edema, which reduces the amount of oxygen that can enter the blood and causes difficulty breathing^[4].

Numerous studies in humans have demonstrated an association between fluid overload, adverse events, and higher rates of death in hospitalized patients^[8]. This is why it’s important to seek medical attention if you experience symptoms of hypervolaemia, especially if they worsen or spread to other parts of your body^[1].