Hypervolemic

Hypervolemic is a medical term describing an excess of fluid in the body's extracellular spaces, including the intravascular compartment and interstitial tissue. It denotes fluid overload that results from an imbalance between fluid intake, retention, and excretion. Hypervolemia is commonly related to conditions that impair the body’s ability to regulate fluids, such as heart failure, kidney disease, liver cirrhosis with ascites, nephrotic syndrome, and iatrogenic fluid administration.

Pathophysiology of hypervolemia involves an overall increase in total body sodium and water, frequently with sodium retention out of proportion to losses. This expands circulating volume and raises venous pressures, contributing to edema, ascites, and, if the lungs are involved, pulmonary edema and dyspnea. Neurohormonal systems activated by reduced effective arterial blood volume can further promote sodium and water retention, perpetuating the fluid overload.

Common etiologies include congestive heart failure, where reduced cardiac output triggers fluid-retaining mechanisms; chronic kidney disease or nephrotic syndrome, which decrease fluid and sodium excretion; and liver cirrhosis, where altered hemodynamics promote water retention and ascites. Iatrogenic hypervolemia from excessive intravenous fluids or transfusions is another important cause.

Clinical features often include peripheral edema, weight gain, ascites, jugular venous distention, shortness of breath, orthopnea, and crackles on lung examination. Diagnosis relies on history, physical examination, and supporting tests such as elevated BNP in heart failure, electrolyte measurements, and imaging showing edema or pleural effusions.

Management focuses on treating the underlying disorder and reducing fluid overload. This typically includes fluid and sodium restriction, diuretics (for example, loop diuretics with monitoring of electrolytes and renal function), and, in refractory cases, dialysis or ultrafiltration. Prognosis depends on the underlying cause and response to therapy.