Edema in Palliative Care

Edema, anasarca and effusion in body cavities—such as pleural effusions and ascites—are common in palliative care patients and pose major therapeutic challenges in some cases. Edema has various causes. Mechanical causes (such as physical compression) are linked to the person’s physical organization. Disturbances in the fluid organism, in contrast, indicate insufficient effectiveness of the person’s life organization: fluid has been deposited in a “third space” and is no longer properly integrated into the patient’s life processes. Fluid has now collected in different areas of the organism, following gravity. A person’s soul organization (which governs sensation and consciousness) can also be involved in the formation of edema, having withdrawn from its connection with the organism. Thus, the person accumulates fluid and develops “facial edemas” when asleep, which disappear again upon awakening. Another example of this is hypothyroidism, which leads not only to changes in consciousness, but also to increasing accumulation of fluid up to and including myxedema. Finally, edema development is modulated by the “I”-organization: edema tends to develop in the paralytic legs of stroke patients, which they can no longer move out of their own volition. These subtle members which together constitute the human being have deserted their dynamic activity in the person’s metabolic-limb system with an edema. Often processes of congestion follow: fibrosis and other sclerosing processes may develop. The patient’s sensory organization and spirit are no longer connected to the edematous area in their body: the patient feels that his congested (and, often cooler) limbs are heavy and that they no longer rightly belong to him.

We accordingly require a multimodal approach to treat edema, which, in addition to diuretic therapy, aims to support the patient’s life organization, stimulate their sentient organization and strengthen the activity of their “I”.