title: Impact of hyponatremia on frequency of complications in patients with decompensated liver cirrhosis.
abstract: BACKGROUND
  Hyponatremia is common in cirrhosis. The relationship between hyponatremia and severity of cirrhosis is evidenced by its close association with the occurrence of complications, the prevalence of hepatic encephalopathy, hepatorenal syndrome, spontaneous bacterial peritonitis, refectory ascites, and hepatic hydrothorax. The aim of this study was assess the impact of hyponatremia on the occurrence of both liver-related complications and the hemodynamic cardiovascular dysfunction.
  
  
  METHODS
  This prospective study was conducted in 2015 on 74 patients with liver cirrhosis. The patients were from the Gastroenterology and Hepatology Department of Theodor Bilharz Research Institute in Giza, Egypt. The patients were divided into three groups according to their serum level of sodium. Group 1 included 30 patients with serum sodium >135 meq/L, group 2 included 24 patients with serum sodium between135 and 125 meq/L, and group 3 included 20 patients with serum sodium <125 meq/L. For each of the patients, we conducted aclinical examination, laboratory investigations, chest X-ray, ECG, abdominal sonar, and echocardiography.
  
  
  RESULTS
  Hyponatremia was found in 59.46% of our cirrhotic patients, and they showed significantly increased Model for End-Stage Liver Disease (MELD) score, MELD-Na score, QTc interval, Pulmonary vascular resistance (PVR) and inferior vena cava (IVC) collapsibility, and decreased SVR and IVC diameter. Also hepatic encephalopathy, ascites, renal failure, infectious complications, and pleural effusion were significantly more common in hyponatremic cirrhotic patients.
  
  
  CONCLUSIONS
  In cirrhosis, hyponatremia is more common in severe cardiovascular dysfunction and associated with increased risk of hepatic encephalopathy, ascites, illness severity scores, renal failure, infectious complications, and pleural effusion. We recommend selective oral administration of vasopressin V2-receptor antagonist, tolvaptan, which acts to increase the excretion of free water, thereby resolving hypervolemic hyponatremia and may have the potential to improve outcomes in these patients.
authors.affiliation: Intensive Care Department, Theodor Bilharz Research Institute, Giza, Egypt.
authors.forename: Ashraf Abd El-Khalik
authors.initials: AA
authors.lastname: Barakat
authors.affiliation: Intensive Care Department, Theodor Bilharz Research Institute, Giza, Egypt.
authors.forename: Amna Ahmed
authors.initials: AA
authors.lastname: Metwaly
authors.affiliation: Intensive Care Department, Theodor Bilharz Research Institute, Giza, Egypt.
authors.forename: Fatma Mohammad
authors.initials: FM
authors.lastname: Nasr
authors.affiliation: Gastroenterology and Hepatology Department, Theodor Bilharz Research Institute, Giza, Egypt.
authors.forename: Maged
authors.initials: M
authors.lastname: El-Ghannam
authors.affiliation: Gastroenterology and Hepatology Department, Theodor Bilharz Research Institute, Giza, Egypt.
authors.forename: Mohamed Darwish
authors.initials: MD
authors.lastname: El-Talkawy
authors.affiliation: Biostatistics and Demography, Medical Statistician, Environment research Department, Theodor Bilharz Research Institute, Giza, Egypt.
authors.forename: Hoda Abu
authors.initials: HA
authors.lastname: Taleb
keywords: ascites; hepatic encephalopathy; hepatorenal syndrome; hyponatremia; liver cirrhosis