This condition occurs most often in postpubertal, young to middle-aged, obese females. It is a diagnosis of exclusion when physical exam and laboratory investigations fail to define an underlying cause (cardiac, hepatic or renal) for edema. In 80% of cases, the edema is orthostatic, that is, the edema develops in the standing position and is more evident at the end of the day. The edema usually presents in the lower extremities but can also present in the face, hands and breasts, particularly in the morning. This can be demonstrated by weight gains of 0.7–1 kg/day from morning to evening weight.10 An altered homeostatic response to an upright position promotes the retention of sodium and water.
Consider nonpharmacologic measures such as restriction of sodium and fluid intake, recumbent position, avoidance of prolonged periods of standing and use of supportive compression stockings.
Consider discontinuation of diuretic therapy.
Reassess fluid-restricted diet if rebound edema persists when diuretics are stopped. Sodium retention due to neurohormonal adaptation may persist for 1–3 weeks before spontaneous induction of diuresis.
Consider intermittent daily diuretic use only when nonpharmacologic measures fail.