[Hyponatremia in liver cirrhosis: pathogenesis and treatment].
Hyponatremia is the most common electrolyte disorder in patients with cirrhosis. This disorder can be a result of substantial loss of extracellular fluid "hypotonic or hypovolemic hyponatremia" or develop in the context of an increase in extracellular fluid volume and in the absence of major sodium losses; this situation occurs in patients with advanced cirrhosis and is known as "dilutional or hypervolemic hyponatremia". In dilutional or hypervolemic hyponatremia, serum sodium concentration is reduced, plasma volume is increased (although the effective plasma volume is decreased due to marked arterial vasodilation in the splanchnic circulation) and extracellular fluid volume is increased, with ascites and edema in the absence of signs of dehydration. This is a result of the marked deterioration in renal excretion of solute-free water, leading to disproportionate water retention in relation to sodium retention. Hypotonic hyponatremia represents 10% of all hyponatremias in patients with cirrhosis. Since hypervolemic hyponatremia is by far the most frequent form of this disorder, the present chapter will concentrate specifically on hypervolemic hyponatremia in cirrhosis.
Servei d'Hepatologia, Hospital Clínic de Barcelona, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August-Pi-Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain.
Mónica
M
Guevara
Pere
P
Ginès
D065092:Antidiuretic Hormone Receptor Antagonists; D001201:Ascites / Q000378:metabolism; D001810:Blood Volume; D000075202:Contraindications; D018450:Disease Progression; D004231:Diuresis; D045604:Extracellular Fluid / Q000378:metabolism; D006801:Humans; D007010:Hyponatremia / Q000188:drug therapy / Q000209:etiology* / Q000628:therapy; D007177:Inappropriate ADH Syndrome / Q000209:etiology / Q000503:physiopathology; D007668:Kidney / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000150:complications* / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery; D016031:Liver Transplantation; D009318:Natriuresis; D011379:Prognosis; D012462:Saline Solution, Hypertonic / Q000627:therapeutic use; D013152:Splanchnic Circulation; D014664:Vasodilation; D014667:Vasopressins / Q000502:physiology
D065092:Antidiuretic Hormone Receptor Antagonists; D012462:Saline Solution, Hypertonic; D014667:Vasopressins