What is anasarca?

Anasarca is general swelling of the whole body that can occur when the tissues of the body retain too much fluid. The condition is also known as extreme generalized edema.

Accumulation of fluid may occur due to any illnesses and conditions that change the proteins of the body, affect the balance of fluids, or create abnormalities in the blood vessels or lymphatic system.

Often, if anasarca is present, it is a sign of severe organ damage or illness.

Definition of anasarca

It is helpful to understand that anasarca is not a disease itself. Instead, it is a symptom or result of a medical condition.

Anasarca is different than typical edema. Almost everyone experiences swelling at some time, which can be due to a variety of causes, such as an injury, dehydration, or a minor side effect of medication.

In many instances, swelling or edema may only affect a specific part of the body, such as the feet, hands, or legs.

But with anasarca, the swelling involves the whole body and is considered severe. For example, the swelling is often so severe it makes movement difficult.

Treatment of anasarca

It is essential to find out what is causing anasarca to treat it accurately. For example, if kidney disease is causing anasarca, treatment is needed to assist kidney function.

Also, doctors often prescribe medications to treat the severe swelling.


Doctors often prescribe drugs called diuretics. Diuretics work by helping the kidneys release more salt into the urine, which causes the release of more fluid through urination.

The two main types of diuretics prescribed for anasarca include potassium-sparing and loop diuretics. Diuretics are either taken by mouth or given through an intravenous line (IV). The choice of diuretic, the dose, and the route of administration vary according to the severity of the swelling and the underlying condition that is causing anasarca.


Albumin is a protein made by the body that is necessary for a variety of important functions, including balancing fluid. In cases of poor nutrition and certain serious medical conditions, the level of albumin can become too low. When this occurs fluid from the bloodstream is pushed out into the tissues causing swelling. In some cases, replacing albumin can help correct this problem.


A doctor may recommend additional home treatments to speed recovery. Monitoring fluid and salt intake is important to prevent any swelling from getting worse. Salt can increase fluid retention, which is why people who have severe edema need to reduce their salt intake.

What are the causes?

Anasarca can develop due to a variety of causes. Some conditions that may lead to anasarca are widespread, while others are considered rare.

The most common causes of anasarca include:

  • Excess administration of intravenous fluids: Intravenous fluids are often administered in the hospital to treat several conditions, such as shock, dehydration, and infection. But if the body cannot adapt to the fluids given, it can lead to severe edema
  • Kidney disease: When kidney function is impaired, fluid is not removed from the body adequately, which can cause anasarca.
  • Cirrhosis: Cirrhosis can occur due to liver failure. Liver disease can cause changes in the hormones that affect fluid regulation in the body. When the liver does not work as efficiently as it should, it can cause fluid to leak into the tissues.
  • Malnutrition: Malnutrition, specifically protein deficiency in the diet, can cause fluid to accumulate in the tissues. In extreme cases, it can lead to anasarca.
  • Poor heart function: When the muscle of the heart does not work correctly, it affects how well the heart pumps blood throughout the body. If the heart is not pumping efficiently, it can cause fluid to build up in the tissues.
  • Allergic reaction: Swelling of the body can occur due to an allergic reaction. In severe reactions, anasarca can develop.

Less common causes include:

Capillary leak syndrome

Capillary leak syndrome occurs when protein and fluid leak out of the blood vessels into the tissues of the body. The cause is not well understood, but it is believed to be due to inflammation and blood vessel injury. It has been shown to occur in relation to some medications and toxins.

According to one case study, capillary leak syndrome can develop as a result of certain cancermedications, such as gemcitabine. Another case was reported following a snakebite.

A side effect of medication

Various medications can lead to anasarca. The most common types of medication that might cause swelling include steroids and blood pressure drugs, such as amlodipine. Discontinuing the medication will often resolve symptoms of anasarca as indicated in this case report.

Anasarca symptoms

The main symptom of anasarca is swelling of the body. The swelling is obvious, and the skin may look shiny and stretched. Sometimes, swelling is so extreme that a person has difficulty moving.

Swelling can become so severe that fluid will leak out directly from the skin. This is known as weeping edema.

Pitting edema may also develop. Pitting edema occurs when pressure is applied to the swollen skin, and a dimple or indentation remains after the pressure is released.

The swelling often causes additional symptoms including:

  • trouble walking if the legs are swollen
  • difficulty lifting arms
  • increased heart rate
  • aching joints
  • difficulty breathing

A life-threatening complication of anasarca can also develop if fluid accumulates in the lungs. Fluid in the lungs is called pulmonary edema, and it can quickly become an emergency. Signs of pulmonary edema include chest pain, shortness of breath, and coughing.

How is anasarca diagnosed?

A doctor can usually make a diagnosis of anasarca after a physical exam; and if the edema is severe, a doctor can often recognize it instantly. However, determining the underlying cause of anasarca requires further tests.

A blood test is often the first step in making a diagnosis of anasarca. Blood is tested to check the function of organs including the heart, lungs, liver, and kidneys.

A doctor will also take a medical history to help determine whether any underlying medical conditions are causing the fluid retention. A doctor may also recommend other diagnostic tests, such as an echocardiogram, a chest X-ray, and a stress test to evaluate heart and lung function.


Anasarca often occurs due to severe organ damage or illness. It may interfere with a person’s ability to perform everyday activities and can greatly decrease their quality of life. But with proper treatment, swelling can often be reduced. Although medication can help treat the condition, anasarca might return if the underlying cause cannot be corrected.

The outlook for people with anasarca often depends on identifying the cause. In many instances, by the time anasarca has developed, the underlying condition has progressed to a critical state.

Treating problems with the heart, lungs, kidneys, and liver early on is the best chance of preventing and controlling anasarca in many cases.

Anasarca in Dogs

What is Anasarca? Puppies born with anasarca are commonly called walrus puppies, swimmer puppies, rubber puppies or water puppies. This is because they are born with a deadly amount of fluid underneath their skin. There is still not enough research done to truly understand why puppies are born with the condition. Some researchers believe that it occurs when puppies are in the birth canal too long and trauma from the contractions causes swelling, however, this is speculative.

Anasarca is generalized edema, this includes lymphedema and is often associated with nephrotic syndrome, hypoproteinemia or liver failure resulting from infectious canine hepatitis. Anasarca is a life-threatening condition that is most common in the brachycephalic breeds, such as English Bulldogs, French Bulldogs, Pugs, Boston Terriers and Bull Mastiffs. Yorkshire Terriers, Cocker Spaniels, German Shepherd Dogs, Tervurens and Australian Shepherds have been known to have anasarca.

Symptoms of Anasarca in Dogs

It can be difficult to determine if an expectant mother is carrying a puppy that has anasarca. Some breeders and veterinarians have reported noticing the following symptoms in pregnant dogs:

  • Additional weight gain resulting from excessive fluid
  • Water ring around the teats
  • Swollen mammary glands
  • Shifting of puppies from one side to another
  • Leakage from the vulva

Many breeders opt to have an ultrasound performed about two weeks before their dog’s expected due date. The ultrasound will show if there is an oversized puppy that appears to have excessive water retention in comparison to the other puppies in the uterus.

Puppies born with anasarca will have the following symptoms:

Bloated or distorted features

Rubber looking skin

Flat chest with front legs splayed

Swollen or distended abdomen, legs and or head

Causes of Anasarca in Dogs

Puppies that have excess fluid build up can be born with up to five times their normal weight. All puppies can be affected, but generally only one or two puppies are affected with anasarca. Puppies born with anasarca have a very low survival rate, puppies that are severely swollen with excess fluid are at risk of their skin splitting open or their abdomen rupturing from the swelling.

Researchers believe that anasarca is a congenital problem but it is still unclear if this is an inherited condition except in English and French Bulldogs. Some researchers believe that environment also plays a part in the development of anasarca in neonatal puppies. There has not been enough research conducted on anasarca in dogs to definitively report the exact cause of anasarca in dogs.

Diagnosis of Anasarca in Dogs

Only an ultrasound during the later phases of pregnancy can detect whether or not a pregnant female is carrying a puppy that has anasarca. If the entire litter is affected, an ultrasound may not be effective since the puppies are compared to each other looking for abnormalities that would indicate excessive fluid build up.

When a puppy is born with anasarca, it is usually very obvious from the visible symptoms that are present. The puppy will have swollen, distorted features and will have a rubber-like appearance to its skin and body.

Your veterinarian will need to run additional tests on the puppy to determine the extent of the fluid build up and any organ damage that has been done. Generally, a puppy that is diagnosed with anasarca will have a low chance of survival.

Treatment of Anasarca in Dogs

Puppies that are mildly affected with anasarca have the highest chance of survival and your veterinarian will probably suggest that the puppy be hospitalized while undergoing treatments. Puppies that are severely affected with anasarca are generally recommended for euthanasia.

Treatments include elevating the puppy’s head and also extending the neck to clear the airway so your puppy can breathe easier. Urination will need to be encouraged, puppies cannot urinate on their own when they are first born and they will need to be stimulated in order for them to express their bladder.

Lasix is becoming an accepted treatment for puppies diagnosed with anasarca. Lasix is chemical furosemide which is a diuretic saluretic. This means that Lasix will inhibit the resorption of sodium. Lasix is administered intravenously immediately after birth.

Your puppy will need to be on a warming blanket or put in a warming chamber to regulate body temperature. Breathing will begin to level out as the excess fluid is being expressed from your puppy. Mildly affected puppies will take between one to two hours to begin breathing normally. Moderately affected puppies have a lower survival rate and will take anywhere from an hour and a half to four hours to begin breathing normally.

Recovery of Anasarca in Dogs

Most puppies that are severely affected by anasarca will not survive; they generally drown in the excess fluid within 30 minutes of being born. Euthanasia is recommended for these puppies so they do not suffer needlessly. Puppies that do survive anasarca can grow normally and lead healthy lives. There are occasions when damage to the puppy’s organs has occurred and the puppy does have health issues that continue for their lifetime.

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