Spironolactone-furosemide combination therapy and acid-base disorders in liver cirrhosis patients


Respiratory alkalosis (RA) and dilutional hyperchloremic acidosis (DHA) are the most common acid-base balance (ABB) disorders in patients with liver cirrhosis. The aims of this study were to clarify whether RA develops in relation to DHA via respiratory compensation of metabolic acidosis and whether spironolactone in combination with low-dose furosemide - diuretics known to ameliorate DHA - positively affects RA in liver cirrhosis patients.

59 patients with advanced cirrhosis were divided into two groups. Group D consisted of individuals (urine sodium concentration (U_Na+) > 20 mmol/L) who responded to combination therapy consisting of spironolactone and low-dose furosemide. The non-D group consisted of individuals (U_Na+ ≤ 20 mmol/L) who either did not respond to the treatment or who were not administered it. In both groups, we examined serum and urine concentrations of electrolytes and ABB parameters, including S_Na+-S_Cl- and S_Na+/S_Cl- values.

In group D, we found a statistically significant relationship between pCO₂ and S_HCO3-: r = 0.756 (p < 0.001) and between pCO₂ and S_Na+-S_Cl-: r = 0.522 (p = 0.001). Neither S_alb nor the corrected anion gap were associated with changes in S_HCO3- or pCO₂ values. Although S_HCO3- values were normal, abnormal pCO₂ values were observed in one third of group D patients. Based on multivariable analysis, S_HCO3- proved to be a statistically significant influencing factor on pCO₂ values.

DHA contributes to the development of RA in individuals with liver cirrhosis. Reducing DHA by means of effective diuretic therapy comprising spironolactone and furosemide has a beneficial effect on RA in such patients.