💧 Edema · Nephrotic, Cardiac & Hepatic · Pediatric Decision Tool

Schwartz Clinical Handbook — Chapter 31 · Periorbital edema · Ascites · Proteinuria · Hypoalbuminemia · JVP · Hepatomegaly

Select edema distribution (periorbital, generalized, dependent), associated symptoms (proteinuria, hypertension, respiratory distress, jaundice), and labs → differentiate nephrotic syndrome, heart failure, cirrhosis, protein‑losing enteropathy, or angioedema.
⚠️ Red flags: respiratory distress, anasarca, oliguria, hypertension → urgent nephrology/cardiology evaluation.

📋 Step 1 — Edema pattern & systemic clues
📌 Diagnostic impressions
📖 Schwartz Ch 31

Select edema location, vital signs, urine dipstick, albumin, and organ‑specific signs → system identifies nephrotic syndrome (proteinuria, hypoalbuminemia), heart failure (tachycardia, gallop, hepatomegaly), cirrhosis (jaundice, ascites), or protein‑losing enteropathy (stool α1‑AT).

✔️ Nephrotic: periorbital edema, generalized anasarca, proteinuria 4+, low albumin.
✔️ CHF: lower extremity edema, JVD, S3 gallop, rales.
✔️ Cirrhosis: ascites, jaundice, spider angiomas, low albumin.
✔️ Angioedema: sudden onset, lips/tongue/face, non‑pitting.
📘 Schwartz pearls (Chapter 31)
• Nephrotic syndrome: urine protein/creatinine ratio >2, treat with steroids (MCNS).
• Edema + hypoalbuminemia + normal urine protein → consider PLE (α1‑antitrypsin stool).
• Diuretics: furosemide for volume overload, spironolactone for cirrhosis.
• IV albumin indicated for tense ascites or respiratory compromise in nephrosis.