Pathogenesis and treatment of fluid and electrolyte imbalance in cirrhosis

Patients with cirrhosis have significant abnormalities in their fluid and electrolyte balance, this is manifested mainly by the development of ascites and edema. Ascites is the most common complication of patients with cirrhosis and its development constitutes the first and most important manifestation of the disease. Patients with advanced cirrhosis and portal hypertension often show an abnormal extracellular fluid volume regulation, which results in accumulation of fluid as ascites, pleural effusion, or edema. This abnormality in volume regulation is associated with significant changes in the splanchnic circulation and renal circulation that induce sodium and water retention. During the last decade significant advances have been accomplished in regard to the pathogenesis and the treatment ascites. The description of a new hypothesis, the identification of new vasoactive factors involved in the pathogenesis of arterial vasodilation and the introduction of different therapeutic modalities such as therapeutic paracentesis, transjugular intrahepatic portosystemic shunt, aquaretics agents, and liver transplantation are all proof of this. Likewise, the description of predictive factors for the survival of patients with cirrhosis has been of major importance for the identification of patients candidates for liver transplantation.