Hyponatremia in cirrhosis: pathophysiology and management.
Hyponatremia in cirrhosis: pathophysiology and management.
John S, Thuluvath PJ
PMID: 25805925
Hyponatremia is frequently accompanied by ascites or portal hypertension as a complication of advanced liver cirrhosis. Although ascites do not appear in the early stages, cirrhosis progresses and ascites leads to kidney damage by eliminating solute-free water, which causes water retention due to compensatory mechanisms such as non-osmotic secretion of ADH (eg arginine vasopressin) Hyponatremia will occur. In patients with cirrhosis, hyponatremia increases morbidity and mortality and is an important prognostic factor before and after liver transplant. In this case, conventional therapy for hyponatremia is fluid restriction and loop diuretics, but it is often inefficacious, and this paper deals with pathophysiology and various treatments. In this paper, hyponatremia in patients with cirrhosis is the main indication of correction, with serum sodium below 120 and hyponatremia with neurologic symptoms. Hypertonic saline is used to prevent osmotic demyelination syndrome just before liver transplant when serum sodium <110. The vasopressin receptor antagonist has not been approved by the FDA for the treatment of hyponatremia in patients with liver disease or cirrhosis, and the selective and efficient use of an oral V2 receptor antagonist would be a major development in hyponatremia management without major side effects.
John S, Thuluvath PJ
PMID: 25805925
Hyponatremia is frequently accompanied by ascites or portal hypertension as a complication of advanced liver cirrhosis. Although ascites do not appear in the early stages, cirrhosis progresses and ascites leads to kidney damage by eliminating solute-free water, which causes water retention due to compensatory mechanisms such as non-osmotic secretion of ADH (eg arginine vasopressin) Hyponatremia will occur. In patients with cirrhosis, hyponatremia increases morbidity and mortality and is an important prognostic factor before and after liver transplant. In this case, conventional therapy for hyponatremia is fluid restriction and loop diuretics, but it is often inefficacious, and this paper deals with pathophysiology and various treatments. In this paper, hyponatremia in patients with cirrhosis is the main indication of correction, with serum sodium below 120 and hyponatremia with neurologic symptoms. Hypertonic saline is used to prevent osmotic demyelination syndrome just before liver transplant when serum sodium <110. The vasopressin receptor antagonist has not been approved by the FDA for the treatment of hyponatremia in patients with liver disease or cirrhosis, and the selective and efficient use of an oral V2 receptor antagonist would be a major development in hyponatremia management without major side effects.
