The American Journal of Digestive Diseases

, Volume 21, Issue 3, pp 249–256

Prognostic value of spontaneous hyponatremia in cirrhosis with ascites

  • Vicente Arroyo
  • Juan Rodés
  • Miguel A. Gutiérrez-Lizárraga
  • Luís Revert
Original Articles

Abstract

Spontaneous hyponatremia in cirrhosis with ascites is generally considered to be due to an impaired renal ability to excrete free water, to be a contraindication of diuretics, and to be a bad prognostic sign. These concepts are reviewed in this paper. 55 cirrhotics with ascites were divided into three groups. Group I consisted of 13 patients with hyponatremia and very low free-water clearance (\(C_{H_2 O} \), 0.07±0.26 ml/min). These patients also had poor renal function: low inulin clearance (CINU, 40.6±25.9 ml/min) and paraamino-hippurate clearance (CPAH, 383±275 ml/min). Group II consisted of 8 patients who also had hyponatremia.\(C_{H_2 O} \), CINU, and CPAH in these patients were fairly high: 5.85±1.53 ml/min, 85.7±26.2 ml/min, and 651±294 ml/min. These values are similar to those of the 34 patients without hyponatremia who make up Group III: (6.37±4.27 ml/min, 94.7±33.1 ml/min, and 598±199 ml/min). Hyponatremia in Group I could be related to the impaired free-water clearance. The mechanism of hyponatremia in Group II patients is not clear. Patients with hyponatremia and low CINU and CPAH had a negative response to diuretics and a poor prognosis. Patients with hyponatremia but with relatively good renal function had a good prognosis, similar to Group III patients. They responded to diuretics with no worsening of their hyponatremia.

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References

  1. 1.
    Arroyo V, Rodés J, Sánchez-Tapias JM, et al: Trastornos hidroelectrolíticos en la cirrosis hepática con ascitis. Rev Clín Esp 124:469–475, 1971Google Scholar
  2. 2.
    Sherlock S, Senewiratne B, Scott, A, et al: Complications of diuretic treatment in hepatic cirrhosis. Lancet 1:1049–1053, 1966PubMedGoogle Scholar
  3. 3.
    Nelson WP III, Rosenbaum JD, Strauss MB: Hyponatremia in hepatic cirrhosis following paracentesis. J Clin Invest 30:738–744, 1951PubMedGoogle Scholar
  4. 4.
    Talso PJ, Stafford W, Ferenci G, et al: Paradoxical hyponatremia associated with congestive heart failure and with cirrhosis of the liver. Metabolism 5:58–69, 1956PubMedGoogle Scholar
  5. 5.
    Birkenfeld LW, Leibman J, O'Meara MP, et al: Total exchangeable sodium, total exchangeable potassium, and total body water in edematous patients with cirrhosis of the liver and congestive heart failure. J Clin Invest 37:687–698, 1958PubMedGoogle Scholar
  6. 6.
    Summerskill WHJ. Ascites—the kidney in liver diseases. Diseases of the liver. 3rd ed. L Schiff (ed) J.B. Lippincott Company, 1969, chap 11Google Scholar
  7. 7.
    Shear L, Kleinerman J, Gabuzda GJ: Renal failure in patients with cirrhosis of the liver. I. Clinical and pathologic characteristics. Am J Med 39:184–198, 1965PubMedGoogle Scholar
  8. 8.
    Leaf A: The clinical and physiological significance of serum sodium concentration. N Eng J Med 267:77–83, 1962Google Scholar
  9. 9.
    Gabuzda GJ: Cirrhosis, ascites and edema. Clinical course related to management. Gastroenterology 58:546–553, 1970Google Scholar
  10. 10.
    Baldus WP, Feichter RN, Summerskill WHJ, et al: The kidney in cirrhosis. II. Disorders in renal function. Ann Int Med 60:366–377, 1964PubMedGoogle Scholar
  11. 11.
    Martini GA: Gibt es ein Hepatorrenales Syndrom? Deutsch Med Wschr 87:2408–2419, 1962Google Scholar
  12. 12.
    Summerskill WHJ, Baldus WP, Feichter RN: Renal function in cirrhosis with ascites; clinical, biochemical and physiologic changes. Aktuelle Probleme des Hepatologie. Ultrastruktur, Steroidstoffwechsel, Durchblutung, Leber und Niere. GA Martini, S Sherlock (eds). Stuttgart, Georg Thieme Verlag, 1962, pp 90–98Google Scholar
  13. 13.
    Summerskill WHJ: Pathogenesis and treatment of disorders of water and electrolyte metabolism in hepatic disease. Proc Mayo Clin 35:89–97, 1960PubMedGoogle Scholar
  14. 14.
    Vesin P: Water, Electrolyte and Acid-base disorders in liver disease. Clinical disorders of fluid and electrolyte metabolism MH Maxwell, CR Kleeman (eds): New York, McGraw-Hill, 1972 chap 23Google Scholar
  15. 15.
    Heyrowsky A: A new method for the determination of inulin in plasma and urine. Clin Chim Acta 1:470–478, 1956PubMedGoogle Scholar
  16. 16.
    Brun C: A rapid method for the determination of paraaminohippuric acid in kidney function test. J Lab Clin Med 37:955–962, 1951PubMedGoogle Scholar
  17. 17.
    Peters JP, Van Slyke DD: Quantitative Clinical Chemistry. Baltimore, Williams & Wilkins 1932, vol 2Google Scholar
  18. 18.
    Shear L, Hall WP, Gabuzda GJ: Renal failure in patients with cirrhosis of the liver. II Factors influencing maximal urinary flow rate. am J Med 39:199–209, 1965PubMedGoogle Scholar
  19. 19.
    Lancestremere LG, Davidson PL, Earley LE, et al: Renal failure in Laennec cirrhosis. III. Diuretic response to administered water. J Lab Clin Med 60:967–975, 1962PubMedGoogle Scholar
  20. 20.
    Ralli EP, Robson RS, Clarke D, et al.: Factors influencing ascites in patients with cirrhosis of the liver. J Clin Invest 24:316–325, 1945Google Scholar
  21. 21.
    Nelson WP, Welt LG: The effects of pittresin on the metabolism and excretion of water and electrolytes in normal subjects and patients with ascites and cirrhosis. J Clin Invest 31:392–400, 1952PubMedGoogle Scholar
  22. 22.
    White AG, Rubin G, Leitter C: Studies in edema IV. Water retention and the antidiuretic hormone in hepatic and cardiac disease. J Clin Invest 32:931–939, 1953PubMedGoogle Scholar
  23. 23.
    Schedl HP, Bartter FC: An explanation for and experimental correction of the abnormal water diuresis in cirrhosis. J Clin Invest 39:248–261, 1960PubMedGoogle Scholar
  24. 24.
    Kleeman CR, Water metabolism. Clinical disorders of fluid and electrolyte mechanism. MH Maxwell, CR Kleeman (eds): New York, McGraw-Hill, 1972, chap 7Google Scholar
  25. 25.
    Flear CTG: Hyponatremia.: Lancet 2:164–166, 1974Google Scholar
  26. 26.
    Takasu T, Laskern N, Shalhoub RJ: Mechanism of hyponatremia in chronic congestive heart failure. Ann Int Med 55:368–383, 1961PubMedGoogle Scholar
  27. 27.
    Fuisz RE: Hyponatremia. Medicine 42:149–164, 1963PubMedGoogle Scholar
  28. 28.
    Earley LE, Sanders CA: The effect of changing serum osmolality on the release of antidiuretic hormone in certain patients with decompensated cirrhosis of the liver and low osmolality. J clin Invest 38:545–550, 1959PubMedGoogle Scholar

Copyright information

© Digestive Disease Systems, Inc. 1976

Authors and Affiliations

  • Vicente Arroyo
    • 1
  • Juan Rodés
    • 1
  • Miguel A. Gutiérrez-Lizárraga
    • 1
  • Luís Revert
    • 1
  1. 1.Liver Unit and Renal Department, Hospital ClínicoUniversity of BarcelonaBarcelonaSpain
  2. 2.Unidad de HepatologíaHospital Clínico y ProvincialBarcelonaSpain

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