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Notes of hyponatremia treatment(cirrhosis)

Hyponatremia is the common type of electrolyte imbalance in patients with decompensated liver cirrhosis , the incidence rate is 21.6% ~ 35%. Hyponatremia is closely associated with jaundice, refractory ascites, hepatic encephalopathy, hepatorenal syndrome, it threat the survival rate seriously. Hyponatremia is an important indicator of poor prognosis of liver cirrhosis. In the course of treatment of liver cirrhosis, hyponatremia is a difficulty and emphasis.

Cause of hyponatremia: Abnormal secretion of Arginine vasopressin (AVP) is an important cause of hyponatremia in patients with cirrhosis. Especially patients with ascites, increased AVP secretion causing dilutional hyponatremia.Endothelin, nitric oxide and other vasodilators are also involved in the progress of cirrhosis hyponatremia. In addition, there is a possibility that for patients with cirrhosis,such as inappropriate sodium restriction, diuretic way, ascites puncture also cause hyponatremia.

Notes of hyponatremia treatment:

Sodium Correction Rate in Hyponatremia. If the correct speed quickly, neurological sequelae may occur. If correction Rate was limited, the osmotic demyelination syndrome can be avoided. Best corrected rate is ≤ 8mmol/L per day, please detect the urinary excretion and sodium concentration frequently.

Water restriction. Dilutional hyponatremia: Although water restrictions may prevent a further decline of serum sodium, but it has a side effect for the retention of sodium and water. Most patients can not tolerate strict water restrictions.

Hypertonic solution of sodium. Hypertonic solution of sodium may partly improve hyponatremia, but maintain time is not long, and likely to cause severe edema and ascites. However, if blood sodium levels below 110mmol / L or falling too fast, may be appropriately supplement hypertonic sodium chloride solution.

Diuretics. Proper use of diuretics is the key to avoid the hyponatremia. In recent years, several studies have shown that drug combination (such as furosemide and spironolactone) may keep an acceptable level of controlling ascite for 90% of patients with cirrhosis . It is worth noting that the disease status of patients may affect the efficacy and safety of diuretics, such as alcoholic liver disease patients are prone to hypokalemia, once hypokalemia, must be suspended furosemide. Patients with liver transplant or kidney disease are poor tolerance for spironolactone, prone to hyperkalemia, should be combined with the use of furosemide.

If the central nervous system (CNS) abnormalities are minor, use of diuretic therapy and isotonic saline infusion should be continued. When the patient's state of consciousness has improved significantly, hypertonic saline solution may be used to increase the serum sodium concentration, but furosemide and hypertonic saline should not be used together.

Aquaretics. It is currently the most popular treatment of hyponatremia. However, it’s therapeutic effect can not be sustained,can not improve survival rate, and it is expensive. We hope it will be more long-term efficacy.

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