Intravenous albumin infusion is an effective therapy for hyponatraemia in cirrhotic patients with ascites.

McCormick, P. Aiden; Mistry, Pramod K.; Kaye, Graham; Burroughs, AK; McIntyre, N

doi:10.1136/gut.31.2.204

Cited by 90 publications

(54 citation statements)

References 17 publications

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“…Finally, albumin has been shown to improve serum sodium concentration in a few studies, but the number of patients included has been low, and the follow-up has been short. 35,36 …”

Section: Management Of Hyponatremiamentioning

confidence: 99%

Hyponatremia in cirrhosis: Pathogenesis, clinical significance, and management

Ginès¹,

Guevara²

2008

Hepatology

278

269

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Hyponatremia is a frequent complication of advanced cirrhosis related to an impairment in the renal capacity to eliminate solute-free water that causes a retention of water that is disproportionate to the retention of sodium, thus causing a reduction in serum sodium concentration and hypo-osmolality. The main pathogenic factor responsible for hyponatremia is a nonosmotic hypersecretion of arginine vasopressin (or antidiuretic hormone) from the neurohypophysis related to circulatory dysfunction. Hyponatremia in cirrhosis is associated with increased morbidity and mortality. There is evidence suggesting that hyponatremia may affect brain function and predispose to hepatic encephalopathy. Hyponatremia also represents a risk factor for liver transplantation as it is associated with increased frequency of complications and impaired short-term survival after transplantation. The current standard of care based on fluid restriction is unsatisfactory. Currently, a new family of drugs, known as vaptans, which act by antagonizing specifically the effects of arginine vasopressin on the V2 receptors located in the kidney tubules, is being evaluated for their role in the management of hyponatremia. The short-term treatment with vaptans is associated with a marked increase in renal solute-free water excretion and improvement of hyponatremia. Long-term administration of vaptans seems to be effective in maintaining the improvement of serum sodium concentration, but the available information is still limited. Treatment with vaptans represents a novel approach to improving serum sodium concentration in cirrhosis.

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“…Finally, albumin has been shown to improve serum sodium concentration in a few studies, but the number of patients included has been low, and the follow-up has been short. 35,36 …”

Section: Management Of Hyponatremiamentioning

confidence: 99%

Hyponatremia in cirrhosis: Pathogenesis, clinical significance, and management

Ginès¹,

Guevara²

2008

Hepatology

278

269

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“…Furthermore, the hepatic synthetic dysfunction associated with cirrhosis leads to abnormally low serum levels of albumin, a negatively charged protein that helps maintain adequate plasma oncotic pressure [7] . Albumin therapy for intravascular volume expansion in cirrhosis was introduced as early as the 1950s, and has been shown in small studies to be superior to normal saline or fluid restriction for correcting serum sodium in cirrhotics [7][8][9] . Nevertheless, it remains unclear whether volume resuscitation with colloid albumin infusion is more effective than crystalloid in the correction of hyponatremia in hospitalized patients with decompensated cirrhosis.…”

Section: Resultsmentioning

confidence: 99%

Benefit of Albumin Infusion in Hospitalized Patients With Cirrhosis and Hyponatremia: A Retrospective Cohort Study

Shen

Barraza

Anam

et al. 2017

Journal of Gastroenterology and Hepatology Research

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Journal of Gastroenterology and Hepatology Researchwere analyzed. Patient characteristics, quantity and type of fluid administered, change in serum sodium, and 6-month mortality were recorded. RESULTS: A total of 146 eligible patients were identified, of which 62% (91/146) received primarily crystalloid and 38% (55/146) primarily albumin resuscitative fluid. Those within the albumin cohort were more likely to receive diuretics (82% vs 56%, p = 0.001), have a history of refractory ascites (56% vs 21%, p < 0.001), ascites on admission (96% vs 60%, p < 0.001), higher admission body mass (81.6 kg vs 75.5 kg, p = 0.04), higher creatinine (152.9 µmol/L vs 130.8 µmol/L, p = 0.03), and higher model for end-stage liver disease (MELD) score (23.0 vs 18.9, p = 0.002) compared to those in the crystalloid cohort. Fluid selection did not impact sodium correction (p = 0.67). In multivariate analysis, receiving albumin and having higher baseline serum albumin were both associated with reduced 6-month mortality, odds ratio of 0.06 (p = 0.013) and 0.13 (p = 0.035), respectively. CONCLUSIONS: Fluid selection in patients with cirrhosis and hyponatremia insignificantly impacted sodium correction. Albumin infusion was associated with reduced 6-month mortality. Larger prospective trials are required to investigate this relationship.

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“…Treatment for hyponatremia is indicated when the serum sodium is less than 120 meq/L or the patient has neurologic symptoms that might be due to hyponatremia. Patients who are found to be hypovolemic should be adequately resuscitated with intravenous crystalloid or albumin infusion 4,6 . Fluid restriction should be considered if the patient has neurologic symptoms that might be due to hyponatremia or when the serum sodium is less than 120 mEq/L, which occurs in about 1% of patients with cirrhosis.…”

Section: Importance Of Hyponatremiamentioning

confidence: 99%

A Study on Hyponatremia in Decompensated Liver Disease

Devadas¹

2017

jmscr

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Intravenous albumin infusion is an effective therapy for hyponatraemia in cirrhotic patients with ascites.

Cited by 90 publications

References 17 publications

Hyponatremia in cirrhosis: Pathogenesis, clinical significance, and management

Hyponatremia in cirrhosis: Pathogenesis, clinical significance, and management

Benefit of Albumin Infusion in Hospitalized Patients With Cirrhosis and Hyponatremia: A Retrospective Cohort Study

A Study on Hyponatremia in Decompensated Liver Disease

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