Total paracentesis in cirrhotic patients with tense ascites and dilutional hyponatremia.
OBJECTIVE
The safety of large-volume paracentesis with plasma expander infusion in ascitic cirrhotic patients with advanced liver disease, hyponatremia, or renal failure has not been elucidated. Our aim was to investigate the safety of total paracentesis in cirrhotic patients with ascites and severe hyponatremia.


METHODS
Forty-five cirrhotic patients with tense ascites were treated with total paracentesis and infusion of plasma expanders. At inclusion, 20 patients showed severe hyponatremia (serum sodium <130 mEq/L). In the remaining 25 patients, serum sodium was >130 mEq/L (range, 133-146 mEq/L).


RESULTS
Plasma renin activity (PRA) and plasma aldosterone concentration (PAC) were significantly higher in patients with hyponatremia (PRA: 19.7 +/- 5.8 ng/mL/h; PAC: 217 +/- 35 ng/dL) than in those patients without hyponatremia (PRA: 4.9 +/- 1.1 ng/mL/h; PAC: 95 +/- 31 ng/dL), indicating a more severe systemic hemodynamic deterioration. After paracentesis, PRA and PAC increased similarly in both groups of patients. Serum sodium levels remained unchanged after paracentesis in patients with hyponatremia (127 +/- 0.5 to 128 +/- 1.5 mEq/L) and decreased slightly in patients without hyponatremia (137 +/- 1 to 135 +/- 1 mEq/L; p < 0.005). The incidence of complications during the first hospitalization, the probability of readmission for complications of cirrhosis, and the probability of survival at 1 yr were similar in both groups of patients.


CONCLUSIONS
These results indicate that therapeutic paracentesis is a safe treatment for tense ascites in cirrhotic patients with severe hyponatremia.
Vila
M C
MC
Liver Section, Gastroenterology Unit, Hospital del Mar, Universitat Autònoma de Barcelona, Spain.
Coll
S
S
Solà
R
R
Andreu
M
M
Gana
J
J
Marquez
J
J
D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000097:blood; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007010:Hyponatremia / Q000097:blood / Q000401:mortality / Q000628:therapy*; D007677:Kidney Function Tests; D008103:Liver Cirrhosis / Q000097:blood / Q000401:mortality / Q000628:therapy*; D008104:Liver Cirrhosis, Alcoholic / Q000097:blood / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D019152:Paracentesis; D010359:Patient Readmission; D010952:Plasma Substitutes; D011379:Prognosis; D012083:Renin / Q000097:blood; D012964:Sodium / Q000097:blood; D015996:Survival Rate
D010952:Plasma Substitutes; D000450:Aldosterone; D012964:Sodium; D012083:Renin