Hyponatremia in Cirrhosis: An Update
- PMID: 33156095
- DOI: 10.14309/ajg.0000000000000786
Hyponatremia in Cirrhosis: An Update
Abstract
Hyponatremia is frequently seen in patients with ascites secondary to advanced cirrhosis and portal hypertension. Although not apparent in the early stages of cirrhosis, the progression of cirrhosis and portal hypertension leads to splanchnic vasodilation, and this leads to the activation of compensatory mechanisms such as renin-angiotensin-aldosterone system (RAAS), sympathetic nervous system, and antidiuretic hormone (ADH) to ameliorate low circulatory volume. The net effect is the avid retention of sodium and water to compensate for the low effective circulatory volume, resulting in the development of ascites. These compensatory mechanisms lead to impairment of the kidneys to eliminate solute-free water in decompensated cirrhosis. Nonosmotic secretion of antidiuretic hormone (ADH), also known as arginine vasopressin, further worsens excess water retention and thereby hyponatremia. The management of hyponatremia in this setting is a challenge as conventional therapies for hyponatremia including fluid restriction and correction of hypokalemia are frequently inefficacious. In this review, we discuss the pathophysiology, complications, and various treatment modalities, including albumin infusion, selective vasopressin receptor antagonists, or hypertonic saline for patients with severe hyponatremia and those awaiting liver transplantation.
Comment in
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Hyponatremia in Cirrhosis: Role of Vasopressors.Am J Gastroenterol. 2021 Jul 1;116(7):1561. doi: 10.14309/ajg.0000000000001177. Am J Gastroenterol. 2021. PMID: 33734115 No abstract available.
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Measuring Serum Sodium in Cirrhosis: Regarding "Hyponatremia in Cirrhosis: An Update".Am J Gastroenterol. 2021 Apr;116(4):835. doi: 10.14309/ajg.0000000000001011. Am J Gastroenterol. 2021. PMID: 33982959 No abstract available.
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Reply to Morton.Am J Gastroenterol. 2021 Apr;116(4):835-836. doi: 10.14309/ajg.0000000000001047. Am J Gastroenterol. 2021. PMID: 33982960 No abstract available.
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