title: Treatment of hyponatremic cirrhosis with ascites resistant to diuretics by urea.
abstract: We have studied the efficacy of urea in the treatment of hyponatremia and hydrosaline retention in cirrhotic patients with ascites resistant to diuretics. In 5 patients with hyponatremia and ascites resistant to a major diuretic treatment (200-400 mg spironolactone combined with 40-160 mg furosemide/day for 4 of them), urea intake (30-90 g/day) induced the following changes: the daily weight changed from a gain of 0.01 +/- 0.06 kg/day to a loss of 1.03 +/- 0.12 kg/day (p less than 0.001) (mean +/- SEM), serum sodium concentration rose from 128 +/- 1.3 to 133 +/- 1.4 mmol/l (p less than 0.01), sodium output increased from 24 +/- 4 to 82.5 +/- 11 mmol/day, diuresis increased from 1.05 +/- 0.10 to 2.24 +/- 0.24 liters/day (p less than 0.01). Despite an important weight loss, the creatinine clearance did not change significantly (53.6 +/- 4.5 ml/min before and 70.0 +/- 8.2 ml/min during urea). In patients responding to classical diuretics, urea as a monotherapy was less effective. From the 6 patients with resistant ascites, only 1 developed prerenal uremia after urea treatment. In order to enhance urea efficacy, it is important to take it together with a long-loop diuretic. Intermittent urea intake seemed to be useful in cirrhotic patients with hyponatremia associated with ascites resistant to diuretics and with low or normal blood urea concentrations.
mesh_terms: D000328:Adult; D001201:Ascites / Q000097:blood / Q000150:complications* / Q000188:drug therapy / Q000378:metabolism / Q000652:urine; D001835:Body Weight; D003404:Creatinine / Q000378:metabolism; D004359:Drug Therapy, Combination; D004487:Edema / Q000150:complications / Q000188:drug therapy; D005665:Furosemide / Q000378:metabolism / Q000627:therapeutic use; D006801:Humans; D007010:Hyponatremia / Q000097:blood / Q000150:complications* / Q000188:drug therapy / Q000378:metabolism / Q000652:urine; D008104:Liver Cirrhosis, Alcoholic / Q000097:blood / Q000150:complications / Q000188:drug therapy / Q000378:metabolism / Q000652:urine; D008297:Male; D008875:Middle Aged; D013148:Spironolactone / Q000627:therapeutic use; D014508:Urea / Q000378:metabolism / Q000627:therapeutic use*
chemical_list: D013148:Spironolactone; D005665:Furosemide; D014508:Urea; D003404:Creatinine