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Hyponatremia in Cirrhosis: An Update
Joseph J Alukal1, Savio John2, Paul J Thuluvath1,3
1Institute of Digestive Health and Liver Diseases, Mercy Medical Center, Baltimore, Maryland, USA.
The American Journal of Gastroenterology
|November 6, 2020
Summary
Hyponatremia in advanced cirrhosis with ascites is challenging. This review covers pathophysiology and treatments like vasopressin receptor antagonists for better management.
Area of Science:
- Hepatology
- Nephrology
- Endocrinology
Background:
- Hyponatremia is common in advanced cirrhosis with ascites.
- Cirrhosis progression causes splanchnic vasodilation, activating RAAS, SNS, and ADH.
- These mechanisms lead to sodium/water retention, ascites, and impaired free water excretion.
Purpose of the Study:
- To review the pathophysiology of hyponatremia in cirrhosis.
- To discuss complications and treatment modalities for hyponatremia in this patient population.
Main Methods:
- Literature review of pathophysiology and treatment of hyponatremia in cirrhosis.
- Discussion of conventional and novel therapeutic options.
Main Results:
- Compensatory mechanisms in cirrhosis impair free water excretion.
- Nonosmotic ADH secretion exacerbates water retention and hyponatremia.
- Conventional therapies are often ineffective.
Conclusions:
- Management of hyponatremia in advanced cirrhosis is complex.
- Treatment options include albumin infusion, vasopressin antagonists, and hypertonic saline.
- These therapies are crucial for patients awaiting liver transplantation.
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