Severe Heart Failure And Ascites

[MTbowels]

A very dear friend of mine in his fifties was diagnosed with severe heart failure around a year ago. He has severe abdominal swelling due to ascites along with limited mobility and severe breathlessness. Currently, he is taking a number of diuretic and blood pressure medicines along with warfarin and digoxin.

He went into hospital last month for two weeks and lost 25kg in weight during the period which was said to be fluid loss from the body induced by days of i.v. treatment with furosemide and spironolactone.

He's now developing a number of large fluid-filled blisters on the front of his lower left leg which burst periodically, releasing a colourless water-like fluid. The blisters re-heal and burst again about once each day.

He would like to know exactly what this leaking fluid is called. Is it exactly the same fluid that collects beneath a normal blister? He understands that his body is trying to eliminate excess fluid in this manner, but is puzzled as to where the fluid is coming from. Could it be from his bloodstream?

Thanks

[237SJ]

I would imagine it`s lymphatic fluid (but I`m not an expert)

[Sqad]

A few assumptions here MT, from your post.

Congestive cardiac failure is not the commonest cause of ascites.....cirrhosis of the liver is far commoner..BUT from his treatment, CCF has been established without doubt.

CCF with increasing kidney damage not uncommonly cause these bullae (blisters) on the legs and the fluid is due to the CCF and is almost the same as the ascitic fluid and the fluid in his legs.

Yes the fluid in the blisters does come initially fro the blood stream and is the body's attempt to get rid of more fluid and ease the pressure on the heart and kidneys.

I do not have to tell you that your friend is very ill.

[anneasquith]

one concern would be that these bursting blisters may become infected. has your friend got a health carer ie, district nurse visiting him ?

[MTbowels]

Sqad, you're absolutely right. He's now told me that he was told by his consultant that he had cirrhosis a few months ago. This diagnosis followed an ultrasound scan of his kidneys requested by his GP which revealed a very enlarged spleen. The Kidneys were said to be ok at the time by the ultrasound technician. However, A CT Scan of the spleen performed on the same day showed liver cirrhosis. He also has something called portal hypertension which was said to account for the splenomegaly. The clinicians also seem to think that his failure to respond to warfarin therapy (INR 1.6 last week on 13mg warfarin) may be due to this portal hypertension. He's on warfarin awaiting cardioversion for AF.

Anne, I'm afraid he's one of these people who tries to avoid the medical profession like the plague. He insists he can manage these blisters at home on his own and right now they don't appear infected. The trail of fluid from these blisters he leaves behind him when he struggles to walk has to be seen to be believed - he has to change his socks three times a day.

Thank you both.

[anneasquith]

he could put a sterile dressing on the oozing blisters. any chemist has them,