Clinical Implications, Evaluation, and Management of Hyponatremia in Cirrhosis

Abstract

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Evidence-based hyponatremia management in liver disease

“…128 One proposed approach for the perioperative management of hyponatremia in patients awaiting LT is summarized in Figure 6. 129…”

“…Desmopressin administration as a rescue measure is useful when unintended overcorrection of hyponatremia occurs [ 128 ]. One proposed approach for the perioperative management of hyponatremia in patients awaiting LT is summarized in Figure 6 [ 129 ].…”

Management of Portal Hypertension

“…Hypervolemia is the most common cause of hyponatremia in patients with cirrhosis. 124 The first step in the management of hyponatremia is to stop diuretics after a thorough clinical examination for features of hypervolemia. Free water restriction (<1000 ml/day) is recommended only for patients with serum sodium <125 meq/dl.…”

Overview of Complications in Cirrhosis

“…38 A serum sodium level < 120 mmol/L is reasonable to initiate free water restriction. 39 The accurate estimation of intravascular volume status is essential to make a diagnosis of dilutional hyponatremia and dynamic inferior vena cava indices are more accurate than central venous pressure estimation. 40 Thuluvath et al assessed the impact of hyponatremia in 10,187 patients and found that AKI (50.3% vs. 32.8%, P < 0.001) and sepsis (16.8% vs. 11.8%, P < 0.001) were more common in patients with hyponatremia than those without.…”

“…Albumin infusion is the mainstay of therapy in cirrhosis with hyponatremia. 39 In patients with serum Na <110 mmol/L or when patients present with seizures or coma attributable to electrolyte imbalance, hyponatremia needs correction by administering hypertonic saline. 41 Vaptans are vasopressin receptor antagonists which have been used to treat hyponatremia in heart failure.…”