Harrison's PodClass: Internal Medicine Cases and Board Prep Ep 171: A 19-Year-Old Woman with Lower Extremity Edema
Nov 6, 2025
Dive into the intriguing case of a malnourished 19-year-old grappling with lower extremity edema. Explore the Starling mechanism behind her pitting edema, as hosts break down hydrostatic and oncotic pressures. Discover how heart failure contributes to fluid accumulation and why compression stockings can be effective. The discussion also highlights the importance of hypoalbuminemia in her condition. This episode combines clinical teaching with engaging insights on physiology, making complex concepts accessible for all.
AI Snips
Chapters
Books
Transcript
Episode notes
Malnourished Patient With Knee-Deep Edema
- A 19-year-old woman with long-standing anorexia nervosa was admitted for supervised refeeding and had pitting edema to her knees.
- She was markedly malnourished with BMI 16, low muscle and fat, and signs like thin hair and brittle nails.
Starling Equation Controls Capillary Fluid Flux
- The Starling equation predicts net fluid movement across capillaries from hydrostatic and oncotic gradients and capillary permeability.
- The protein reflection coefficient scales how effectively the membrane retains proteins and thus influences oncotic forces.
Address Low Oncotic Pressure In Edema
- Low intravascular oncotic pressure from hypoalbuminemia permits fluid to leave capillaries and causes dependent edema.
- Recognize malnutrition or chronic liver disease as causes and address low serum albumin when treating edema.
