HYPERVOLEMIA: WHAT CAUSES EXCESS FLUID IN THE BODY?

Medically Reviewed by Dr. Sony Sherpa, (MBBS) - September 27, 2024

Hypervolemia is a condition of excessive fluid retention in the body. The prevalence of hypervolemia is challenging to estimate. While not as common as some other medical conditions, hypervolemia can affect individuals of all ages and backgrounds.

Fluid overload does not occur in isolation. It often serves as a warning sign for underlying medical issues affecting organs responsible for fluid balance, such as the kidneys, heart, or liver. Early detection and treatment are necessary to avoid complications.

In this article, we will explore what hypervolemia is, its risk factors, symptoms, and treatment options.

What Is Hypervolemia?

Hypervolemia is a medical condition where there is an excessive amount of fluid in the body. It is also sometimes referred to as fluid excess or fluid overload.

In hypervolemia, total extracellular fluid volume exceeds normal levels, leading to various health concerns. Extracellular fluid is any fluid outside the cell, composed of plasma and lymph fluid. It is vital in transporting nutrients and waste products, maintaining blood pressure, and lubricating tissues.

The main reason for fluid overload is excess intake or ineffective removal of fluids from the body. Sodium levels are generally seen to be higher, yet they may fluctuate, resulting in the retention of sodium and fluids.^[1]

Adults' recommended daily fluid intake is 1.5 to 2.5 liters per day. The standard daily sodium intake is approximately 2,300mg or 70 millimoles administered intravenously. Age, physical activity levels, and health conditions may affect intake.

The kidneys maintain the body's fluid balance, which filters out excess fluid and waste products from the blood. A disrupted balance can lead to hypervolemia.

The kidneys also maintain fluid and sodium levels in the body by responding to changes in vasopressin secretion (osmotic hormone) and urine concentration. If there is not enough sodium, the body's renin-angiotensin-aldosterone system will be activated, resulting in a decrease in sodium in the urine.^[2]

The body’s response to elevated sodium is slow, and even healthy individuals take a while to get rid of the excess sodium.

Causes of Hypervolemia

Causes fall into two main categories: primary and secondary.

Primary causes arise from an imbalance in fluid intake and output, often due to excessive fluid intake that exceeds the body's ability to remove it effectively.

Common primary causes include^[3]:

• Excessive Fluid Intake

Elevated Salt Consumption: High sodium levels and kidney issues lead to water retention as the body attempts to dilute the sodium concentration in the blood.

Excess Intravenous Fluids: Extravasation can lead to hypervolemia. Receiving too much fluid through IV therapy can cause extravasation, which overwhelms the body's ability to remove excess liquid. This issue is more prevalent in individuals with compromised kidney function. It is vital to receive therapy from skilled healthcare professionals to minimize potential risks and complications.

• Inadequate Fluid Drainage

Lymphatic System Dysfunction: Blockages or abnormalities in the lymphatic system, responsible for draining fluid from tissues, can impede fluid removal and contribute to fluid overload.

• Hormonal Imbalances

Pregnancy and Premenstrual Edema: While a rare occurrence, both of these conditions are known to increase the risk of hypervolemia. Some research shows that female reproductive hormones can slightly increase extracellular fluid levels.

Mineralocorticoid Excess: Hormones like aldosterone regulate sodium and water balance. Excessive production of osmotic hormones can lead to sodium and water retention, contributing to hypervolemia.

Secondary causes stem from underlying medical conditions affecting organs involved in fluid balance, such as:

• Kidney disease
• Heart failure
• Liver cirrhosis
• Prolonged hypertension
• Hormone disorders

Understanding the specific cause of fluid overload is crucial for tailoring an effective treatment plan.

Risk Factors for Hypervolemia

Several aspects can increase the likelihood of developing hypervolemia. These include:

• Sodium and water intake: Consuming a diet high in sodium and water can lead to fluid retention in the body, increasing the risk of fluid overload.
• Fluid management issues: People with conditions that affect fluid management in the body, such as congestive heart failure, kidney disease, or liver failure, are at a higher risk of developing fluid excess.
• Medications: Certain prescriptions, such as corticosteroids, NSAIDs, antidepressants, antihypertensives, and some antifungals, can impair your kidneys' ability to excrete water, potentially leading to fluid overload. Those affecting hormones, such as birth control pills and hormone replacement therapy, could also increase the risk.
• Age: As we age, our body's ability to regulate fluid balance decreases, making older adults more susceptible to fluid overload.

Hypervolemia Symptoms

The symptoms of hypervolemia can deviate depending on the condition’s severity and cause.

Hypervolemia can cause an increase in heart rate due to the body's increased workload. The heart beats harder to send blood through the body, compensating for excess fluid buildup.

Some common symptoms include^[4]:

• Sudden weight gain.
• Shortness of breath or breathing difficulty
• Swelling in the abdomen (ascites), legs, ankles, and feet
• High blood pressure caused by pressure on the blood vessels
• Fatigue and feebleness
• Decreased urine output or dark-colored urine

In some cases, hypervolemia can progress to severe symptoms. Symptoms may include severe shortness of breath, difficulty breathing while lying down (orthopnea), chest pain, rapid heart rate, confusion, and sudden weight gain.

If you experience any of these symptoms, seek immediate medical assistance.

Hypervolemia Complications

If left untreated, hypervolemia can lead to severe complications, including:

• Heart failure: The excess fluid in the body can strain the heart, leading to congestive heart failure.
• Kidney damage: The kidneys may not be able to filter out the excess fluid, leading to kidney damage or renal failure.
• Pulmonary edema: As the fluid accumulates in the lungs, it can cause pulmonary edema, making breathing difficult.
• Nephrotic Syndrome: Hypervolemia can cause damage to the kidneys, leading to nephrotic syndrome, a condition where the kidneys dump high amounts of protein into the urine.

When to Call a Doctor

Do not wait for severe symptoms to appear. Consult a healthcare professional if you experience any persistent symptoms of hypervolemia, such as unexplained weight gain, swelling in your legs, ankles, or feet, shortness of breath, or fatigue.

Early intervention can avert complications and improve your overall health.

Diagnosis of Hypervolemia

If you are experiencing symptoms of hypervolemia, your doctor will execute a physical exam and question you about your medical history.

They may also order some tests to confirm the diagnosis, including:

• Blood tests to measure sodium levels and other electrolytes, indicating a fluid imbalance.
• Urine tests to help determine the amount of protein and other substances in the urine, which can indicate kidney damage.

Severe symptoms often require additional testing:

• A chest X-ray can help recognize fluid accumulation in the lungs.
• An echocardiogram uses sound waves to render images of the heart that can discern any heart problems causing hypervolemia.

Treatment of Hypervolemia

The treatment for hypervolemia aims to eliminate excess body fluid and depends on the underlying cause and severity.

Diuretics can help the body eliminate excess fluid through increased urine output. These medications are the first port of call in treating the condition.

In extreme cases of hypervolemia, medications for lowering blood pressure might be prescribed. Examples include ACE inhibitors and beta-blockers.

They may also recommend kidney dialysis to remove excess fluid from the body^[5].

A healthcare professional may additionally recommend the following:

• Fluid restriction: If the excess fluid is due to excessive intake, your doctor may recommend limiting your fluid intake. You still need to drink water if you have hypervolemia.
• Sodium restriction: Limiting your sodium intake can help reduce fluid retention in the body.

Prevention

Preserving the health of the kidneys and adrenal glands is vital for preventing fluid excess. Hypervolemia prevention can be achieved by:

1. Remaining hydrated and eating hydrating foods like fruits and vegetables.
2. Monitoring sodium intake to avoid health problems.
3. Supporting a healthy weight through balanced eating and routine physical activity.

Remember to schedule regular checkups with healthcare professionals for early prevention of health issues.

Hypervolemia vs. Hypovolemia

Hypervolemia and hypovolemia are two conditions that affect the body's fluid balance, but they are opposites. While hypervolemia is an excess of fluid in the body, hypovolemia indicates an abnormal decrease in the body's fluid volume.

Dehydration, excessive sweating, and blood loss can all lead to hypovolemia, while fluid retention and inadequate removal often contribute to hypervolemia.^[6]

Takeaways

Hypervolemia, or excessive fluid in the body, can be a red flag for underlying medical conditions that can result in dire complications if left untreated. It is critical to recognize the signs and seek medical attention if you suspect you have hypervolemia. With proper treatment and management, you can prevent complications and maintain a healthy fluid balance in the body.

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