Hyponatremia in Cirrhosis: An Update.
Acute Kidney Injury
/ metabolism
Acute-On-Chronic Liver Failure
/ metabolism
Albumins
/ therapeutic use
Antidiuretic Hormone Receptor Antagonists
/ therapeutic use
Ascites
/ metabolism
Fluid Therapy
Hepatic Encephalopathy
/ metabolism
Hepatorenal Syndrome
/ metabolism
Humans
Hypertension, Portal
/ metabolism
Hyponatremia
/ metabolism
Liver Cirrhosis
/ metabolism
Liver Transplantation
Renin-Angiotensin System
/ physiology
Saline Solution, Hypertonic
/ therapeutic use
Splanchnic Circulation
/ physiology
Tolvaptan
/ therapeutic use
Vasodilation
/ physiology
Vasopressins
/ metabolism
Journal
The American journal of gastroenterology
ISSN: 1572-0241
Titre abrégé: Am J Gastroenterol
Pays: United States
ID NLM: 0421030
Informations de publication
Date de publication:
11 2020
11 2020
Historique:
entrez:
6
11
2020
pubmed:
7
11
2020
medline:
15
12
2020
Statut:
ppublish
Résumé
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.
Identifiants
pubmed: 33156095
doi: 10.14309/ajg.0000000000000786
pii: 00000434-202011000-00011
doi:
Substances chimiques
Albumins
0
Antidiuretic Hormone Receptor Antagonists
0
Saline Solution, Hypertonic
0
Vasopressins
11000-17-2
Tolvaptan
21G72T1950
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
1775-1785Commentaires et corrections
Type : CommentIn
Type : CommentIn
Type : CommentIn
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