Distribution of body water in patients with cirrhosis: The effect of liver transplantation

Abstract

We compared total body water and intracellular-extracellular distribution of body water between male patients with mild liver disease without ascites (n = 9), male patients with severe liver disease and gross ascites (n = 6) and a group of age-, sex-, height- and weight- matched controls (n = 6). In addition, we documented the effects of liver transplantation on intracellular, extracellular and total body water in 12 patients (6 men and 6 women) by means of deuterium oxide dilution and whole-body potassium counting. We saw no significant difference in total body water between the healthy controls, patients without ascites and patients with ascites (46.5 +/- 9.2 kg, 45.4 +/- 6.6 kg and 50.4 +/- 5.1 kg, respectively), although, as expected, extracellular water was increased in patients with ascites compared with healthy controls and cirrhotic patients without ascites (36.9 +/- 6.5 kg vs. 25.4 +/- 4.4 kg, p = 0.005; and 36.9 +/- 6.5 kg vs. 27.0 +/- 5.3 kg, p = 0.002, respectively). We found no difference between non-ascitic patients and healthy controls (25.4 +/- 4.4 kg vs. 27.0 +/- 5.3 kg). However, intracellular water was significantly reduced in patients with severe liver disease compared with that in controls (13.6 +/- 3.3 kg vs. 21.5 +/- 4.2 kg, p = 0.005) or patients without ascites (13.6 +/- 3.3 kg vs. 18.3 +/- 2.9 kg, p = 0.01). The reduction of intracellular water appears to be due to loss of body cell mass.(ABSTRACT TRUNCATED AT 250 WORDS)

Multi-frequency bioelectric impedance measurements for predicting body water compartments in patients with non-ascitic liver cirrhosis

“…A preliminary study aimed at establishing the time needed by 2H,0 and Br to reach equilibrium was done on the plasma of five unselected cirrhotic patients. Both tracers reached equilibrium 2.5 h after their administration, a time similar to that for healthy subjects and very close to that obtained by others for TBW (McCullough et al 1991 ;Prijatmoko et al 1994;Zillikens et al 1992a) and ECW (Crawford et al 1993;McCullough et al 1991) of nonascitic cirrhotics. Following this finding, blood samples for 'H,O and Br measurements were taken just before the tracer load and 3-5 h later in both cirrhotic and control subjects.…”

“…Water retention is common in the later stages of liver cirrhosis (Schober et al 1979;McCullough et al 1991;Zillikens et al 1992a;Crawford et al 1993;Prijatmoko et al 1994). The increase in TBW is largely due to an expansion of extracellular water (ECW;McCullough et al 1991 ;Crawford et al 1993) which may become clinically apparent in the form of oedema or ascites. However, ICW may be expanded also and contribute to the overall increase in TBW (Schober et al 1979).…”

Value of the extracellular water ratio for assessment of cirrhotic patients with and without ascites

“…9 However, in situations where there are clinically important changes in the intracellular and extracellular distribution of water, such as cirrhosis, the value of single-frequency BIA is limited. 3,10,11 Previous studies have indicated an improved prediction of body water compartments by BIA if measurements are made while the frequency of the applied current is changed. [12][13][14] At low frequencies, the current passes through the extracellular fluids because of the capacitance effect of cell membranes and tissue interfaces, whereas at higher frequencies, the current is conducted through both the intra-and extracellular fluids.…”

“…Single‐frequency BIA is a safe, non‐invasive, rapid, and inexpensive method of assessing total body water (TBW) in healthy individuals 9 . However, in situations where there are clinically important changes in the intracellular and extracellular distribution of water, such as cirrhosis, the value of single‐frequency BIA is limited 3,10,11 . Previous studies have indicated an improved prediction of body water compartments by BIA if measurements are made while the frequency of the applied current is changed 12–14 .…”

Effect of liver cirrhosis on body composition: Evidence of significant depletion even in mild disease

“…It has been demonstrated that significant changes in body compartments occur in patients with cirrhosis 9 . These patients have altered body water compartments 10,11 . Some authors have reported an increase in body water even before ascites and edema are obvious 11,12 .…”