Signs and symptoms of fluid overload in dialysis patients

Fluid overload is also called hypervolemia. It's when you have too much fluid in your body. It can be caused by several different conditions including heart failure, kidney failure, cirrhosis, or pregnancy.

What Are the Symptoms of Fluid Overload?

You may have symptoms from the underlying condition that are causing your fluid overload. Fluid overload can be caused by serious conditions and needs to be treated. Call your health care provider if you have any of the following symptoms:‌

Swelling. You may have swelling in your feet, legs, hands, or face. Swelling caused by too much fluid in your body is called edema. It is called pitting edema if you can press on the area of swelling with your thumb and it makes an indentation.

High blood pressure. The extra fluid in your body makes your heart work harder. This raises your blood pressure.

Shortness of breath. It can be difficult for you to breathe if the extra fluid gets in your lungs. You might also make a sound called a crackle when you breathe. You need to see your doctor immediately if you are having any trouble breathing.‌

Discomfort. You might have a headache, stomach bloating, or abdominal cramps which can make you feel uncomfortable.

Weight gain. This is usually the earliest sign of fluid overload. Most people gain 8 to 15 pounds before they notice swelling in their legs or abdomen.‌

Chest pain. This can be a sign of pulmonary edema, which is fluid in your lungs. You need to see your doctor immediately if you experience chest pain.

What Causes Fluid Overload?

Fluid overload happens when your kidneys retain sodium. Your kidneys manage the salt and fluid balance in your body. When something causes your kidneys to retain sodium, it increases the sodium in the rest of your body. This causes your body to produce too much fluid. Several different conditions can cause this, such as: 

Heart failure. When your heart muscle is weak or damaged it doesn't pump blood as well as it should. If your heart muscle gets too stiff, it might also cause the heart to not pump blood as well as it should. Your kidneys may not get enough blood to function properly. Your body retains fluid and salt to try to correct the balance.

Cirrhosis.Liver disease can cause a buildup of scar tissue on your liver. Your liver can't function as well with scar tissue. This can cause fluid to build up in your abdomen.

Kidney failure. Your kidneys clean your blood and get rid of toxins in your body. They also balance the amount of fluid and salt in your body. Fluid can build up in your body when your kidneys are not working the way they should.

Nephrotic syndrome. This is a kidney disorder that is usually caused by damage to small blood vessels in your kidneys. These blood vessels filter waste and extra water from your blood. When they are damaged, your body can't get rid of excess fluid.‌

Other conditions. Fluid overload can also be caused by other conditions such as pregnancy or premenstrual edema.

How Is Fluid Overload Diagnosed?

Your doctor will do a physical exam and talk to you about your symptoms and your medical history. Your doctor may be able to diagnose you with fluid overload based on edema and weight gain. You may also need additional lab or imaging tests to determine the underlying cause.   

How Is Fluid Overload Treated?

Your doctor will treat the underlying cause of your hypervolemia. Treatment options may include:

• Diuretics — medicines that help you get rid of extra fluid
• Dialysis — a treatment that filters your blood through a machine 
• Paracentesis — a procedure that uses a small tube to drain fluid from your abdomen
• Restricting salt intake
• Checking your weight daily

Some causes of fluid overload may respond to lifestyle changes such as:

• Quit smoking
• Take your medicines as directed
• Maintain a healthy weight
• Keep track of how much fluid you drink
• Do not drink too much alcohol
• Eat a healthy diet
• Avoid too much caffeine
• Get enough exercise
• Manage your stress
• Get enough sleep
• Keep track of your blood pressure
• Control your blood sugar if you have diabetes
• Stay up to date with your flu and pneumonia vaccines

What Are the Risks and Complications of Fluid Overload?

Fluid overload can cause serious complications if it isn't treated. Some of these complications are:

• Pulmonary edema
• Heart failure
• Delayed wound healing
• Tissue breakdown
• Problems with your bowel function