Skip to main content
SpringerLink
Log in

Management of Hyponatremia in End-Stage Liver Disease

  • Chapter
  • First Online:
Book cover Critical Care for Potential Liver Transplant Candidates

  • 865 Accesses

Abstract

The proper diagnosis of hyponatremia is a vital component of the perioperative care of liver transplant patients, as hyponatremia is common among patients with end-stage liver disease. The general recommendation for the treatment of chronic hyponatremia is to limit the speed of correction. Unfortunately, the peri-transplantation period is often punctuated by large fluctuations in serum sodium concentration, which increases the risk of neurologic complications and osmotic demyelination syndrome. Consequently, the therapeutic goals and management strategies for hyponatremia vary greatly between the pre-transplantation, intraoperative, and post-transplantation periods. In this chapter, the definition, prognosis, pathophysiology, and treatment of hyponatremia in patients with cirrhosis are reviewed.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Upadhyay A, Jaber BL, Madias NE. Incidence and prevalence of hyponatremia. Am J Med. 2006;119:S30–5. https://doi.org/10.1016/j.amjmed.2006.05.005.

    Article  CAS  PubMed  Google Scholar 

  2. Leung AA, McAlister FA, Rogers SO Jr, Pazo V, Wright A, Bates DW. Preoperative hyponatremia and perioperative complications. Arch Intern Med. 2012;172:1474–81. https://doi.org/10.1001/archinternmed.2012.3992.

    Article  PubMed  Google Scholar 

  3. Angeli P, Wong F, Watson H, Gines P, Investigators C. Hyponatremia in cirrhosis: results of a patient population survey. Hepatology. 2006;44:1535–42. https://doi.org/10.1002/hep.21412.

    Article  CAS  PubMed  Google Scholar 

  4. Guevara M, Baccaro ME, Torre A, Gomez-Anson B, Rios J, Torres F, et al. Hyponatremia is a risk factor of hepatic encephalopathy in patients with cirrhosis: a prospective study with time-dependent analysis. Am J Gastroenterol. 2009;104:1382–9. https://doi.org/10.1038/ajg.2009.293.

    Article  PubMed  Google Scholar 

  5. Gines P, Guevara M. Hyponatremia in cirrhosis: pathogenesis, clinical significance, and management. Hepatology. 2008;48:1002–10. https://doi.org/10.1002/hep.22418.

    Article  CAS  PubMed  Google Scholar 

  6. Amodio P, Del Piccolo F, Petteno E, Mapelli D, Angeli P, Iemmolo R, et al. Prevalence and prognostic value of quantified electroencephalogram (EEG) alterations in cirrhotic patients. J Hepatol. 2001;35:37–45.

    Article  CAS  PubMed  Google Scholar 

  7. Sola E, Watson H, Graupera I, Turon F, Barreto R, Rodriguez E, et al. Factors related to quality of life in patients with cirrhosis and ascites: relevance of serum sodium concentration and leg edema. J Hepatol. 2012;57:1199–206. https://doi.org/10.1016/j.jhep.2012.07.020.

    Article  CAS  PubMed  Google Scholar 

  8. Saab S, Ibrahim AB, Shpaner A, Younossi ZM, Lee C, Durazo F, et al. MELD fails to measure quality of life in liver transplant candidates. Liver Transpl. 2005;11:218–23. https://doi.org/10.1002/lt.20345.

    Article  PubMed  Google Scholar 

  9. Sterns RH, Silver SM. Brain volume regulation in response to hypo-osmolality and its correction. Am J Med. 2006;119:S12–6. https://doi.org/10.1016/j.amjmed.2006.05.003.

    Article  CAS  PubMed  Google Scholar 

  10. Cordoba J, Gottstein J, Blei AT. Chronic hyponatremia exacerbates ammonia-induced brain edema in rats after portacaval anastomosis. J Hepatol. 1998;29:589–94.

    Article  CAS  PubMed  Google Scholar 

  11. Heuman DM, Abou-Assi SG, Habib A, Williams LM, Stravitz RT, Sanyal AJ, et al. Persistent ascites and low serum sodium identify patients with cirrhosis and low MELD scores who are at high risk for early death. Hepatology. 2004;40:802–10. https://doi.org/10.1002/hep.20405.

    Article  PubMed  Google Scholar 

  12. Biggins SW, Rodriguez HJ, Bacchetti P, Bass NM, Roberts JP, Terrault NA. Serum sodium predicts mortality in patients listed for liver transplantation. Hepatology. 2005;41:32–9. https://doi.org/10.1002/hep.20517.

    Article  CAS  PubMed  Google Scholar 

  13. Ruf AE, Kremers WK, Chavez LL, Descalzi VI, Podesta LG, Villamil FG. Addition of serum sodium into the MELD score predicts waiting list mortality better than MELD alone. Liver Transpl. 2005;11:336–43. https://doi.org/10.1002/lt.20329.

    Article  PubMed  Google Scholar 

  14. Kim WR, Biggins SW, Kremers WK, Wiesner RH, Kamath PS, Benson JT, et al. Hyponatremia and mortality among patients on the liver-transplant waiting list. N Engl J Med. 2008;359:1018–26. https://doi.org/10.1056/NEJMoa0801209.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Londono MC, Cardenas A, Guevara M, Quinto L, de Las Heras D, Navasa M, et al. MELD score and serum sodium in the prediction of survival of patients with cirrhosis awaiting liver transplantation. Gut. 2007;56:1283–90. https://doi.org/10.1136/gut.2006.102764.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Cardenas A, Sola E, Rodriguez E, Barreto R, Graupera I, Pavesi M, et al. Hyponatremia influences the outcome of patients with acute-on-chronic liver failure: an analysis of the CANONIC study. Crit Care. 2014;18:700. https://doi.org/10.1186/s13054-014-0700-0.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Machicao VI. Model for end-stage liver disease-sodium score: the evolution in the prioritization of liver transplantation. Clin Liver Dis. 2017;21:275–87. https://doi.org/10.1016/j.cld.2016.12.014.

    Article  PubMed  Google Scholar 

  18. Fisher RA, Heuman DM, Harper AM, Behnke MK, Smith AD, Russo MW, et al. Region 11 MELD Na exception prospective study. Ann Hepatol. 2012;11:62–7.

    CAS  PubMed  Google Scholar 

  19. Sharma P, Schaubel DE, Goodrich NP, Merion RM. Serum sodium and survival benefit of liver transplantation. Liver Transpl. 2015;21:308–13. https://doi.org/10.1002/lt.24063.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Leise MD, Yun BC, Larson JJ, Benson JT, Yang JD, Therneau TM, et al. Effect of the pretransplant serum sodium concentration on outcomes following liver transplantation. Liver Transpl. 2014;20:687–97. https://doi.org/10.1002/lt.23860.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Wang P, Huang G, Tam N, Wu C, Fu S, Hughes BP, et al. Influence of preoperative sodium concentration on outcome of patients with hepatitis B virus cirrhosis after liver transplantation. Eur J Gastroenterol Hepatol. 2016;28:1210–5. https://doi.org/10.1097/MEG.0000000000000690.

    Article  CAS  PubMed  Google Scholar 

  22. Londono MC, Guevara M, Rimola A, Navasa M, Taura P, Mas A, et al. Hyponatremia impairs early posttransplantation outcome in patients with cirrhosis undergoing liver transplantation. Gastroenterology. 2006;130:1135–43. https://doi.org/10.1053/j.gastro.2006.02.017.

    Article  PubMed  Google Scholar 

  23. Dawwas MF, Lewsey JD, Neuberger JM, Gimson AE. The impact of serum sodium concentration on mortality after liver transplantation: a cohort multicenter study. Liver Transpl. 2007;13:1115–24. https://doi.org/10.1002/lt.21154.

    Article  PubMed  Google Scholar 

  24. Urso C, Brucculeri S, Caimi G. Employment of vasopressin receptor antagonists in management of hyponatraemia and volume overload in some clinical conditions. J Clin Pharm Ther. 2015;40:376–85. https://doi.org/10.1111/jcpt.12279.

    Article  CAS  PubMed  Google Scholar 

  25. Asbert M, Gines A, Gines P, Jimenez W, Claria J, Salo J, et al. Circulating levels of endothelin in cirrhosis. Gastroenterology. 1993;104:1485–91.

    Article  CAS  PubMed  Google Scholar 

  26. Bernardi M, Ricci CS, Santi L. Hyponatremia in patients with cirrhosis of the liver. J Clin Med. 2014;4:85–101. https://doi.org/10.3390/jcm4010085.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Spasovski G, Vanholder R, Allolio B, Annane D, Ball S, Bichet D, et al. Clinical practice guideline on diagnosis and treatment of hyponatraemia. Eur J Endocrinol. 2014;170:G1–47. https://doi.org/10.1530/EJE-13-1020.

    Article  CAS  PubMed  Google Scholar 

  28. Sterns RH, Hix JK, Silver SM. Management of hyponatremia in the ICU. Chest. 2013;144:672–9. https://doi.org/10.1378/chest.12-2600.

    Article  PubMed  Google Scholar 

  29. Sterns RH, Nigwekar SU, Hix JK. The treatment of hyponatremia. Semin Nephrol. 2009;29:282–99. https://doi.org/10.1016/j.semnephrol.2009.03.002.

    Article  CAS  PubMed  Google Scholar 

  30. Sterns RH, Hix JK, Silver S. Treating profound hyponatremia: a strategy for controlled correction. Am J Kidney Dis. 2010;56:774–9. https://doi.org/10.1053/j.ajkd.2010.04.020.

    Article  CAS  PubMed  Google Scholar 

  31. Verbalis JG, Goldsmith SR, Greenberg A, Schrier RW, Sterns RH. Hyponatremia treatment guidelines 2007: expert panel recommendations. Am J Med. 2007;120:S1–21. https://doi.org/10.1016/j.amjmed.2007.09.001.

    Article  CAS  PubMed  Google Scholar 

  32. Hoorn EJ, Zietse R. Diagnosis and treatment of hyponatremia: compilation of the guidelines. J Am Soc Nephrol. 2017;28:1340–9. https://doi.org/10.1681/ASN.2016101139.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Norenberg MD. Central pontine myelinolysis: historical and mechanistic considerations. Metab Brain Dis. 2010;25:97–106. https://doi.org/10.1007/s11011-010-9175-0.

    Article  PubMed  Google Scholar 

  34. Gankam Kengne F, Nicaise C, Soupart A, Boom A, Schiettecatte J, Pochet R, et al. Astrocytes are an early target in osmotic demyelination syndrome. J Am Soc Nephrol. 2011;22:1834–45. https://doi.org/10.1681/ASN.2010111127.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Verbalis JG, Goldsmith SR, Greenberg A, Korzelius C, Schrier RW, Sterns RH, et al. Diagnosis, evaluation, and treatment of hyponatremia: expert panel recommendations. Am J Med. 2013;126:S1–42. https://doi.org/10.1016/j.amjmed.2013.07.006.

    Article  PubMed  Google Scholar 

  36. Yun BC, Kim WR, Benson JT, Biggins SW, Therneau TM, Kremers WK, et al. Impact of pretransplant hyponatremia on outcome following liver transplantation. Hepatology. 2009;49:1610–5. https://doi.org/10.1002/hep.22846.

    Article  CAS  PubMed  Google Scholar 

  37. Crivellin C, Cagnin A, Manara R, Boccagni P, Cillo U, Feltracco P, et al. Risk factors for central pontine and extrapontine myelinolysis after liver transplantation: a single-center study. Transplantation. 2015;99:1257–64. https://doi.org/10.1097/TP.0000000000000496.

    Article  PubMed  Google Scholar 

  38. Louis G, Megarbane B, Lavoue S, Lassalle V, Argaud L, Poussel JF, et al. Long-term outcome of patients hospitalized in intensive care units with central or extrapontine myelinolysis. Crit Care Med. 2012;40:970–2. https://doi.org/10.1097/CCM.0b013e318236f152.

    Article  PubMed  Google Scholar 

  39. Ferenci P, Lockwood A, Mullen K, Tarter R, Weissenborn K, Blei AT. Hepatic encephalopathy--definition, nomenclature, diagnosis, and quantification: final report of the working party at the 11th World Congresses of Gastroenterology, Vienna, 1998. Hepatology. 2002;35:716–21. https://doi.org/10.1053/jhep.2002.31250.

    Article  PubMed  Google Scholar 

  40. Lee J, Kim DK, Lee JW, Oh KH, Oh YK, Na KY, et al. Rapid correction rate of hyponatremia as an independent risk factor for neurological complication following liver transplantation. Tohoku J Exp Med. 2013;229:97–105.

    Article  PubMed  Google Scholar 

  41. Hix JK, Silver S, Sterns RH. Diuretic-associated hyponatremia. Semin Nephrol. 2011;31:553–66. https://doi.org/10.1016/j.semnephrol.2011.09.010.

    Article  CAS  PubMed  Google Scholar 

  42. Rose BD, Post TW. Clinical physiology of acid-base and electrolyte disorders. 5th ed. Medical Publishing Division: McGraw-Hill; 2001.

    Google Scholar 

  43. John S, Thuluvath PJ. Hyponatremia in cirrhosis: pathophysiology and management. World J Gastroenterol. 2015;21:3197–205. https://doi.org/10.3748/wjg.v21.i11.3197.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. European Association for the Study of the L. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. J Hepatol. 2010;53:397–417. https://doi.org/10.1016/j.jhep.2010.05.004.

    Article  Google Scholar 

  45. Runyon BA. Introduction to the revised American Association for the Study of Liver Diseases Practice Guideline management of adult patients with ascites due to cirrhosis 2012. Hepatology. 2013;57:1651–3. https://doi.org/10.1002/hep.26359.

    Article  PubMed  Google Scholar 

  46. Rose BD. New approach to disturbances in the plasma sodium concentration. Am J Med. 1986;81:1033–40.

    Article  CAS  PubMed  Google Scholar 

  47. Schrier RW, Gross P, Gheorghiade M, Berl T, Verbalis JG, Czerwiec FS, et al. Tolvaptan, a selective oral vasopressin V2-receptor antagonist, for hyponatremia. N Engl J Med. 2006;355:2099–112. https://doi.org/10.1056/NEJMoa065181.

    Article  CAS  PubMed  Google Scholar 

  48. Wong F, Watson H, Gerbes A, Vilstrup H, Badalamenti S, Bernardi M, et al. Satavaptan for the management of ascites in cirrhosis: efficacy and safety across the spectrum of ascites severity. Gut. 2012;61:108–16. https://doi.org/10.1136/gutjnl-2011-300157.

    Article  CAS  PubMed  Google Scholar 

  49. Torres VE, Chapman AB, Devuyst O, Gansevoort RT, Grantham JJ, Higashihara E, et al. Tolvaptan in patients with autosomal dominant polycystic kidney disease. N Engl J Med. 2012;367:2407–18. https://doi.org/10.1056/NEJMoa1205511.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Dahl E, Gluud LL, Kimer N, Krag A. Meta-analysis: the safety and efficacy of vaptans (tolvaptan, satavaptan and lixivaptan) in cirrhosis with ascites or hyponatraemia. Aliment Pharmacol Ther. 2012;36:619–26. https://doi.org/10.1111/apt.12025.

    Article  CAS  PubMed  Google Scholar 

  51. Rozen-Zvi B, Yahav D, Gheorghiade M, Korzets A, Leibovici L, Gafter U. Vasopressin receptor antagonists for the treatment of hyponatremia: systematic review and meta-analysis. Am J Kidney Dis. 2010;56:325–37. https://doi.org/10.1053/j.ajkd.2010.01.013.

    Article  CAS  PubMed  Google Scholar 

  52. O'Leary JG, Davis GL. Conivaptan increases serum sodium in hyponatremic patients with end-stage liver disease. Liver Transpl. 2009;15:1325–9. https://doi.org/10.1002/lt.21836.

    Article  PubMed  Google Scholar 

  53. Abbasoglu O, Goldstein RM, Vodapally MS, Jennings LW, Levy MF, Husberg BS, et al. Liver transplantation in hyponatremic patients with emphasis on central pontine myelinolysis. Clin Transpl. 1998;12:263–9.

    CAS  Google Scholar 

  54. Miller PD, Linas SL, Schrier RW. Plasma demeclocycline levels and nephrotoxicity. Correlation in hyponatremic cirrhotic patients. JAMA. 1980;243:2513–5.

    Article  CAS  PubMed  Google Scholar 

  55. Gadano A, Moreau R, Pessione F, Trombino C, Giuily N, Sinnassamy P, et al. Aquaretic effects of niravoline, a kappa-opioid agonist, in patients with cirrhosis. J Hepatol. 2000;32:38–42.

    Article  CAS  PubMed  Google Scholar 

  56. Brandman D, Biggins SW, Hameed B, Roberts JP, Terrault NA. Pretransplant severe hepatic encephalopathy, peritransplant sodium and post-liver transplantation morbidity and mortality. Liver Int. 2012;32:158–64. https://doi.org/10.1111/j.1478-3231.2011.02618.x.

    Article  CAS  PubMed  Google Scholar 

  57. Lee EM, Kang JK, Yun SC, Kim KH, Kim SJ, Hwang KS, et al. Risk factors for central pontine and extrapontine myelinolysis following orthotopic liver transplantation. Eur Neurol. 2009;62:362–8. https://doi.org/10.1159/000242426.

    Article  PubMed  Google Scholar 

  58. Morard I, Gasche Y, Kneteman M, Toso C, Mentha A, Meeberg G, et al. Identifying risk factors for central pontine and extrapontine myelinolysis after liver transplantation: a case-control study. Neurocrit Care. 2014;20:287–95. https://doi.org/10.1007/s12028-013-9928-9.

    Article  PubMed  Google Scholar 

  59. Wszolek ZK, McComb RD, Pfeiffer RF, Steg RE, Wood RP, Shaw BW Jr, et al. Pontine and extrapontine myelinolysis following liver transplantation. Relationship to serum sodium. Transplantation. 1989;48:1006–12.

    Article  CAS  PubMed  Google Scholar 

  60. Hudcova J, Ruthazer R, Bonney I, Schumann R. Sodium homeostasis during liver transplantation and correlation with outcomes. Anesth Analg. 2014;119:1420–8. https://doi.org/10.1213/ANE.0000000000000415.

    Article  CAS  PubMed  Google Scholar 

  61. McCormick PA, Mistry P, Kaye G, Burroughs AK, McIntyre N. Intravenous albumin infusion is an effective therapy for hyponatraemia in cirrhotic patients with ascites. Gut. 1990;31:204–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  62. Adrogue HJ, Madias NE. Hyponatremia. N Engl J Med. 2000;342:1581–9. https://doi.org/10.1056/NEJM200005253422107.

    Article  CAS  PubMed  Google Scholar 

  63. Larner AJ, Vickers CR, Adu D, Buckels JA, Elias E, Neuberger J. Correction of severe hyponatraemia by continuous arteriovenous haemofiltration before liver transplantation. BMJ. 1988;297:1514–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  64. Murphy N, Auzinger G, Bernel W, Wendon J. The effect of hypertonic sodium chloride on intracranial pressure in patients with acute liver failure. Hepatology. 2004;39:464–70. https://doi.org/10.1002/hep.20056.

    Article  CAS  PubMed  Google Scholar 

  65. Hackworth WA, Heuman DM, Sanyal AJ, Fisher RA, Sterling RK, Luketic VA, et al. Effect of hyponatraemia on outcomes following orthotopic liver transplantation. Liver Int. 2009;29:1071–7. https://doi.org/10.1111/j.1478-3231.2009.01982.x.

    Article  CAS  PubMed  Google Scholar 

  66. Langer T, Ferrari M, Zazzeron L, Gattinoni L, Caironi P. Effects of intravenous solutions on acid-base equilibrium: from crystalloids to colloids and blood components. Anaesthesiol Intensive Ther. 2014;46:350–60. https://doi.org/10.5603/AIT.2014.0059.

    Article  PubMed  Google Scholar 

  67. Ghaffaripour S, Jannatmakan F, Firoozifar M. Practical protocol for management of severe hyponatremia in patients undergoing liver transplant surgery. Prog Transplant. 2015;25:106. https://doi.org/10.7182/pit2015186.

    Article  PubMed  Google Scholar 

  68. Atchison SR, Rettke SR, Fromme GA, Janossy TA, Kunkel SE, Williamson KR, et al. Plasma glucose concentrations during liver transplantation. Mayo Clin Proc. 1989;64:241–5.

    Article  CAS  PubMed  Google Scholar 

  69. MacMillan TE, Tang T, Cavalcanti RB. Desmopressin to prevent rapid sodium correction in severe hyponatremia: a systematic review. Am J Med. 2015;128:1362 e15–24. https://doi.org/10.1016/j.amjmed.2015.04.040.

    Article  CAS  Google Scholar 

  70. Brinson EL, Yu JS, Liu LL, Bokoch MP. Desmopressin reverses overly rapid serum sodium correction in a hyponatremic patient undergoing living donor liver transplantation: a case report. A A Pract. 2018;11(3):82–4.

    Article  PubMed  Google Scholar 

  71. Bonham CA, Dominguez EA, Fukui MB, Paterson DL, Pankey GA, Wagener MM, et al. Central nervous system lesions in liver transplant recipients: prospective assessment of indications for biopsy and implications for management. Transplantation. 1998;66:1596–604.

    Article  CAS  PubMed  Google Scholar 

  72. Rafat C, Schortgen F, Gaudry S, Bertrand F, Miguel-Montanes R, Labbe V, et al. Use of desmopressin acetate in severe hyponatremia in the intensive care unit. Clin J Am Soc Nephrol. 2014;9:229–37. https://doi.org/10.2215/CJN.00950113.

    Article  CAS  PubMed  Google Scholar 

  73. Perianayagam A, Sterns RH, Silver SM, Grieff M, Mayo R, Hix J, et al. DDAVP is effective in preventing and reversing inadvertent overcorrection of hyponatremia. Clin J Am Soc Nephrol. 2008;3:331–6. https://doi.org/10.2215/CJN.03190807.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  74. Soupart A, Ngassa M, Decaux G. Therapeutic relowering of the serum sodium in a patient after excessive correction of hyponatremia. Clin Nephrol. 1999;51:383–6.

    CAS  PubMed  Google Scholar 

  75. Oya S, Tsutsumi K, Ueki K, Kirino T. Reinduction of hyponatremia to treat central pontine myelinolysis. Neurology. 2001;57:1931–2.

    Article  CAS  PubMed  Google Scholar 

  76. Saner FH, Koeppen S, Meyer M, Kohnle M, Herget-Rosenthal S, Sotiropoulos GC, et al. Treatment of central pontine myelinolysis with plasmapheresis and immunoglobulins in liver transplant patient. Transpl Int. 2008;21:390–1. https://doi.org/10.1111/j.1432-2277.2007.00608.x.

    Article  PubMed  Google Scholar 

  77. Butterworth RF. Pathogenesis of hepatic encephalopathy and brain edema in acute liver failure. J Clin Exp Hepatol. 2015;5:S96–S103. https://doi.org/10.1016/j.jceh.2014.02.004.

    Article  PubMed  Google Scholar 

  78. Wendon J, Cordoba J, Dhawan A, Larsen FS, Manns M, Nevens F, et al. EASL 2017 clinical practice guidelines on the management of acute (fulminant) liver failure. J Hepatol. 2017;66:1047–81. https://doi.org/10.1016/j.jhep.2016.12.003.

    Article  PubMed  Google Scholar 

  79. Lai A, Zeller M, Millen T, Kavsak P, Lamontagne F, Cook D, et al. Chloride concentration of commonly available 5% human albumin solutions. In: Paper presented at the Society of Critical Care Medicine 46th Critical Care Congress, Honolulu, 2016.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesia and Perioperative Care, University of California, San Francisco, School of Medicine, San Francisco, CA, USA

    Vanessa G. Henke, Michael P. Bokoch & Linda L. Liu

Authors
  1. Vanessa G. Henke
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael P. Bokoch
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Linda L. Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Linda L. Liu .

Editor information

Editors and Affiliations

  1. Anesthesiology and Perioperative Medicine, Penn State Hershey Medical Center, Hershey, PA, USA

    Dmitri Bezinover

  2. General, Visceral and Transplant Surgery, University of Duisburg-Essen, Essen, Germany

    Fuat Saner

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Henke, V.G., Bokoch, M.P., Liu, L.L. (2019). Management of Hyponatremia in End-Stage Liver Disease. In: Bezinover, D., Saner, F. (eds) Critical Care for Potential Liver Transplant Candidates. Springer, Cham. https://doi.org/10.1007/978-3-319-92934-7_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-92934-7_5

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-92933-0

  • Online ISBN: 978-3-319-92934-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation