Salt and water balance before and after peritoneojugular and portacaval shunts

Renal salt and water handling were studied in a patient who had refractory ascites that were due to alcoholic liver disease. The patient underwent a peritoneojugular shunt that was followed eight weeks later by a portacaval shunt. Ingestion of a 10-mEq sodium diet and albumin infusion had no effect on sodium balance but increased free water clearance before and after the operative procedures. After peritoneojugular shunt, free water clearance and sodium excretion increased. After portacaval shunt, free water clearance decreased and sodium retention occurred.