Importance of Capillary Leak and Nocturia in Defining and Successfully Treating Idiopathic Edema

Idiopathic edema is a disease of unknown etiology in women characterized by swelling of hands and face followed by increasing abdominal and truncal girth, bloating, edema, > 1.4 kg weight gain when in upright posture and nocturia that eliminates the retained fluid to become edema-free on awakening. We review how a capillary leak was determined as the primary pathophysiologic abnormality that induces different clinical presentations. We eliminated weight gains and nocturia in 4 cases of IE by sodium restriction with or without diuretic therapy. We present a case of hyponatremia-induced seizure and coma due to undiagnosed IE from ages 18 to 81. It took nearly 2 years to convince her that she will never have a seizure or suffer from IE if she drank small amounts of water every 3 hours and reduced sodium intake with or without diuretics, respectively. We present a 42-year-old woman with an 8-year history of postural hypotension, dizziness and fainting that led to many bone fractures and dislocated joints. She was home-bound and mentioning nocturia led to a diagnosis of IE where the capillary leak was of such magnitude that she became severely intravascularly volume depleted when standing. Wearing support stockings eliminated the postural hypotension, dizziness and fainting and symptoms of IE with no weight gain or nocturia. Increased capillary leak induces diverse pathophysiologic changes that cause seemingly disparate clinical manifestations. IE is probably much more common than it is perceived to be with many remaining undiagnosed for many years.