Dilutional Hyponatremia in Patients With Cirrhosis and Ascites

Porcel, A.; Díaz, Fernando; Rendón, Paloma; Macías, Manuel; Martín‐Herrera, L.; Girón-González, José A.

doi:10.1001/archinte.162.3.323

Cited by 152 publications

(103 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The frequency of serum sodium Յ130 mmol/L in inpatients was 28%, a figure similar to that reported in previous studies including a lower number of patients compared with the current investigation. 3,[16][17][18] Moreover, our study shows that the occurrence of low serum sodium levels is greater than previously reported, because a further 29% of inpatients had a mild reduction in serum sodium levels (between 131 and 135 mmol/L). Corresponding figures in outpatients were 14% and 26%, respectively.…”

Section: Discussioncontrasting

confidence: 49%

Hyponatremia in cirrhosis: Results of a patient population survey

et al. 2006

View full text Add to dashboard Cite

and the CAPPS InvestigatorsLow serum sodium concentration is an independent predictor of mortality in patients with cirrhosis, but its prevalence and clinical significance is unclear. To evaluate prospectively the prevalence of low serum sodium concentration and the association between serum sodium levels and severity of ascites and complications of cirrhosis, prospective data were collected on 997 consecutive patients from 28 centers in Europe, North and South America, and Asia for a period of 28 days. The prevalence of low serum sodium concentration as defined by a serum sodium concentration <135 mmol/L, <130 mmol/L, <125 mmol/L, and <120 mmol/L was 49.4%, 21.6%, 5.7%, and 1.2%, respectively. The prevalence of low serum sodium levels (<135 mmol/L) was high in both inpatients and outpatients (57% and 40%, respectively). The existence of serum sodium <135 mmol/L was associated with severe ascites, as indicated by high prevalence of refractory ascites, large fluid accumulation rate, frequent use of large-volume paracentesis, and impaired renal function, compared with normal serum sodium levels. Moreover, low serum sodium levels were also associated with greater frequency of hepatic encephalopathy, spontaneous bacterial peritonitis, and hepatorenal syndrome, but not gastrointestinal bleeding. Patients with serum sodium <130 mmol/L had the greatest frequency of these complications, but the frequency was also increased in patients with mild reduction in serum sodium levels (131-135 mmol/L). In conclusion, low serum sodium levels in cirrhosis are associated with severe ascites and high frequency of hepatic encephalopathy, spontaneous bacterial peritonitis, and hepatorenal syndrome. (HEPATOLOGY 2006;44:1535-1542 I mpairment in body water homeostasis is a common feature of advanced cirrhosis. [1][2][3] This is characterized by a higher rate of renal retention of water in relation to sodium due to a reduction in solute-free water clearance. The consequent inability to adjust the amount of water excreted in the urine to the amount of water ingested leads to dilutional hyponatremia. In recent years, great advances have been made in the knowledge of the pathogenesis of reduced solute-free water clearance in patients with advanced cirrhosis. The inability to excrete an adequate amount of solute-free water in the urine is related to several factors, the most important of which is increased vasopressin release. A reduction of effective circulating volume due to arterial splanchnic vasodilation is considered the afferent factor leading to a baroreceptormediated nonosmotic stimulation of vasopressin release in cirrhosis. 4 Additional factors in the pathogenesis of hyponatremia in cirrhosis are thought to be reduced production of solute-free water due to a reduced sodium delivery to the distal tubule as a consequence of reduction of glomerular filtration rate and/or increase of sodium reabsorption in the proximal tubule. [4][5][6][7] Several studies in large cohorts of patients with cirrhosis have shown that the renal ability to...

show abstract

Section: Discussioncontrasting

confidence: 49%

Hyponatremia in cirrhosis: Results of a patient population survey

et al. 2006

View full text Add to dashboard Cite

show abstract

“…Hyponatremia is prevalent in liver cirrhosis and closely associated with hepatorenal syndrome, ascites, encephalopathy, and SBP (Gines et al 1993;Arroyo and Colmenero 2003;Angeli et al 2006;Guevara et al 2009). Hyponatremia has also been reported as a poor prognostic factor in liver cirrhosis and other medical conditions (Borroni et al 2000;Porcel et al 2002;Jenq et al 2010). Recent studies have reported that the nature of the underlying illness as opposed to the severity of hyponatremia can significantly affect the mortality rate associated with hyponatremia (Chawla et al 2011).…”

Section: Discussionmentioning

confidence: 99%

Rapid Correction Rate of Hyponatremia as an Independent Risk Factor for Neurological Complication Following Liver Transplantation

Lee

et al. 2013

Tohoku J. Exp. Med.

View full text Add to dashboard Cite

Hyponatremia is prevalent before liver transplantation and generally corrected immediately after transplantation. However, the clinical significance of correction rate of hyponatremia is not well investigated. The prognostic impact of pre-transplant serum sodium concentrations and post-transplant correction rate of hyponatremia were assessed. A total of 512 patients who received orthotopic liver transplants were enrolled. The correction rate of hyponatremia (delta sodium, ΔNa) was calculated based on the data collected during the first 48 hours following liver transplantation. Outcomes, including in-hospital mortality, delirium, neurological complications, acute kidney injury, and infections, were compared according to the serum sodium levels (sNa < 125, 125-135, and ≥ 135 mmol/L), and the risk factors for in-hospital mortality and neurological complications were analyzed using multivariate logistic regression methods. Patients with severe hyponatremia (sNa < 125 mmol/L) had higher rates of in-hospital mortality (9.6%, P = 0.010), delirium (54.8%, P = 0.003), neurological complications (24.7%, P = 0.003), and acute kidney injury (57.5%, P = 0.005). In multivariate analysis, serum sodium levels (OR = 0.975, P = 0.402) and delta sodium (OR = 1.097, P = 0.066) were not independent risk factors for in-hospital mortality. However, delta sodium (OR = 1.093, P = 0.003) and fast correction rate of hyponatremia (ΔNa ≥ 12 mmol/ L/24h, OR = 3.397, P = 0.023) were significantly associated with post-transplant neurological complications. Pre-transplantation hyponatremia was not independently associated with clinical outcomes. However, rapid correction of hyponatremia is an independent risk factor for the development of post-transplant neurological complications.

show abstract

“…56 Multiple studies found hyponatremia to be associated with poor prognosis, although multivariate analyses have not uniformly demonstrated its independent association with adverse clinical outcomes. 57 In cirrhosis there is also clear evidence of nonosmotic release of AVP, but as with CHF, the precise contributions of baroreceptor-mediated and other neurohormonal factors have not been clearly established. The portal hypertension associated with cirrhosis provides the stimulus for the splanchnic vasodilatation.…”

Section: S8mentioning

confidence: 99%

Hyponatremia Treatment Guidelines 2007: Expert Panel Recommendations

Verbalis

Goldsmith

Greenberg

et al. 2007

The American Journal of Medicine

519

498

View full text Add to dashboard Cite

Although hyponatremia is a common, usually mild, and relatively asymptomatic disorder of electrolytes, acute severe hyponatremia can cause substantial morbidity and mortality, particularly in patients with concomitant disease. In addition, overly rapid correction of chronic hyponatremia can cause severe neurologic deficits and death, and optimal treatment strategies for such cases are not established. Hyponatremia is the most common disorder of electrolytes encountered in clinical practice, occurring in up to 15% to 30% of both acutely and chronically hospitalized patients. 1 Although most cases are mild and relatively asymptomatic, hyponatremia is important clinically because: (1) acute severe hyponatremia can cause substantial morbidity and mortality; (2) mortality is higher in patients with hyponatremia who have a wide range of underlying diseases; and (3) overly rapid correction of chronic hyponatremia can cause severe neurologic deficits and death.Despite knowledge of hyponatremia since the mid-20th century, this common disorder remains incompletely understood in many basic areas because of its association with a plethora of underlying disease states, and its multiple etiologies with differing pathophysiologic mechanisms. 2 Optimal treatment strategies have not been well defined, both for these reasons and because of marked differences in symptomatology and clinical outcomes based on the acuteness or chronicity of the hyponatremia. 3 Vasopressin receptor antagonists have long been anticipated as a more effective method to treat hyponatremia by virtue of their unique aquaretic effect to selectively increase solute-free water excretion by the kidneys. 4 The recent approval of the first such agent, conivaptan, for clinical use by the US Food and Drug Administration (FDA) heralds the beginning of a new era in the management of hyponatremic disorders. However, effective therapy with these agents will require intelligent guidelines for their use. To this end, a panel of experts in hyponatremia convened to review current therapies for hyponatremia and to evaluate the situations in which aquaretic agents should be considered as alternatives or supplements to accepted current therapies. This review is a summary of the conclusions of this panel.

show abstract

Dilutional Hyponatremia in Patients With Cirrhosis and Ascites

Abstract: Hyponatremia is an alteration in patients with advanced liver disease. Although survival is significantly reduced in patients with spontaneous development of hyponatremia, a reduced sodium concentration cannot be considered as a independent predictor of the risk for death.

Cited by 152 publications

References 24 publications

Hyponatremia in cirrhosis: Results of a patient population survey

Hyponatremia in cirrhosis: Results of a patient population survey

Rapid Correction Rate of Hyponatremia as an Independent Risk Factor for Neurological Complication Following Liver Transplantation

Hyponatremia Treatment Guidelines 2007: Expert Panel Recommendations

Contact Info

Product

Resources

About