Profound hyponatremia in cirrhosis: a case report

Abstract

IntroductionCirrhosis of the liver commonly leads to a state of chronic hypervolemic hyponatremia. Profound exacerbation of the hyponatremic state may occur in patients with decompensated cirrhosis in conjunction with acute stressors such as infection or binge alcohol ingestion.Case presentationA 47 year old man with a history of alcoholic cirrhosis presented to the hospital with symptomatic profound hyponatremia (serum sodium concentration of 105 meq/L) due to a recent infection and binge drinking. The patient was treated with antibiotics, diuretics and hypertonic saline and was placed on a fluid restricted diet. The serum sodium level corrected slowly over four days with symptomatic improvement occurring after two days. A brief discussion of the symptoms and treatment of acute and chronic hyponatremia in the setting of cirrhosis is included.ConclusionIn patients with cirrhosis, it is important to recognize the symptoms of hyponatremia, identify and treat any exacerbating conditions early in their course, and correct the serum sodium concentration slowly with frequent monitoring.

Magnesium, Calcium, Potassium, Sodium, Phosphorus, Selenium, Zinc, and Chromium Levels in Alcohol Use Disorder: A Review

“…Sodium presence has a large impact on plasma osmolality, since salts of sodium (chloride and bicarbonate) along with urea and nonelectrolyte glucose are the most inherent osmoles of plasma. Many studies describe reduced plasma sodium levels in alcohol-dependent patients compared to the control group [ 133 , 134 , 135 , 136 , 137 ].…”

Intravenous albumin infusion is an effective therapy for hyponatremia in patient with malignant ascites

“…Acute worsening of chronic hyponatremia can be a result of one of the following factors: Reduced effective arterial volume, generalized hemodynamic derangement with low peripheral resistance, hypothalamic overproduction of ADH (not SIADH), diuretic use, hypotonic fluid ingestion and reduced glomerular filtration. [101213] In our patient, the intravenous infusion of D5 ½ NS which contains hypotonic sodium chloride may be a factor for the acute worsening of the underlying chronic hyponatremia.…”

Problem based review: The patient presenting with hyponatraemia

“…It should also be remembered that hyponatraemia may be a consequence of a more significant chronic illness, such as cirrhosis or heart failure. Hyponatraemia has been shown to be a feature in up to 22% of cases of decompensated liver disease 7,8 and in 27% of patients with heart failure. 9 The history should include detailed enquiry into recent prescribed and non-prescribed medication, and recent diarrhoea or vomiting which may have led to dehydration, and any other symptoms of hypovolaemia.…”