Volume adaptation in chronic liver disease: on the static and dynamic location of water, salt, protein and red cells in cirrhosis.
Adequate size and distribution of the circulating medium are important for cardiovascular function, tissue oxygenation and fluid homoeostasis. Patients with cirrhosis have an abnormal distribution of increased blood volume, increased total vascular compliance and increased arterial compliance. The pattern and temporal relations of plasma and blood volume expansion are important for pathophysiological, diagnostic and therapeutic purposes and depend highly on the type of load (water, saline, oncotic material, red blood cells). In some aspects patients with cirrhosis respond differently from healthy subjects. Thus the reaction during volume expansion may be somewhat blunted, and in advanced cirrhosis, the non-central parts of the circulation in particular, including the splanchnic blood volume, are expanded by a volume load. The use of vasoactive drugs has provided important information on the changes in haemodynamic and homoeostatic mechanisms in patients with cirrhosis. Infusion of oncotic material (preferably albumin) may prevent circulatory dysfunction during certain types of stress. Volume expansion in advanced cirrhosis is qualitatively and quantitively different from that of healthy subjects and those with early cirrhosis. Timely volume handling is essential, but difficult as it is a balance between hypovolaemia and excess extravascular volume loading with further circulatory dysfunction in these patients with a hyperdynamic, but hyporeactive circulation.
Henriksen
J H
JH
Department of Clinical Physiology 239, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark. jens.h.henriksen@hh.hosp.dk
D000222:Adaptation, Physiological; D000818:Animals; D001810:Blood Volume; D001834:Body Water / Q000502:physiology; D002908:Chronic Disease; D004912:Erythrocytes; D006439:Hemodynamics; D006801:Humans; D008103:Liver Cirrhosis / Q000503:physiopathology* / Q000628:therapy; D010952:Plasma Substitutes / Q000627:therapeutic use; D011506:Proteins / Q000502:physiology; D012965:Sodium Chloride
D010952:Plasma Substitutes; D011506:Proteins; D012965:Sodium Chloride