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Hyponatremia Cirrhosis

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https://www.readbyqxmd.com/read/29075291/baseline-renal-function-predicts-hyponatremia-in-liver-cirrhosis-patients-treated-with-terlipressin-for-variceal-bleeding
#1
Sung Eun Kim, Dong Min Jung, Ji Won Park, Yeonmi Ju, Bohyun Lee, Hyoung Su Kim, Ki Tae Suk, Myoung Kuk Jang, Sang Hoon Park, Jun Goo Kang, Jae Seung Soh, Hyun Lim, Ho Suk Kang, Sung Hoon Moon, ChulSik Kim, SeongJin Lee, Jong Hyeok Kim, Myung Seok Lee, Dong Joon Kim, Sung-Hee Ihm, ChoongKee Park
OBJECTIVES: Terlipressin is safely used for acute variceal bleeding. However, side effects, such as hyponatremia, although very rare, can occur. We investigated the development of hyponatremia in cirrhotic patients who had acute variceal bleeding treated with terlipressin and the identification of the risk factors associated with the development of hyponatremia. DESIGN AND METHODS: This retrospective, case-control study investigated 88 cirrhotic patients who developed hyponatremia and 176 controls that did not develop hyponatremia and were matched in terms of age and gender during the same period following terlipressin administration...
2017: Gastroenterology Research and Practice
https://www.readbyqxmd.com/read/28994887/hepatic-hydrothorax-about-a-hospital-serie-of-63-cases
#2
Leila Mouelhi, Oussama Daboussi, Nadia Cheffi, Kaouther El Jery, Yosra Said, Sana Khedher, Mohamed Salem, Radhouane Dabbèche, Fatma Houissa, Taoufik Najjar
BACKGROUND: Hepatic hydrothorax is a less common complication of cirrhosis with an estimated prevalence of 10- 15%. In the vast majority of cases, ascites are also present but significant pleural effusion may develop in patients without ascites. Hepatic hydrothorax is associated with cirrhosis whatever its etiology. The prognosis of hepatic hydrothorax remains unclear and is closely related to available therapeutic options. The aim of our study is to determine the prevalence of hydrothorax in cirrhotic patients, detail its clinical and therapeutic characteristics, and study the evolutive profile of cirrhotic patients with hydrothorax by comparing it to those without hydrothorax...
December 2016: La Tunisie Médicale
https://www.readbyqxmd.com/read/28984014/increased-serum-c-reactive-protein-and-decreased-urinary-aquaporin-2-levels-are-predictive-of-the-efficacy-of-tolvaptan-in-patients-with-liver-cirrhosis
#3
Masato Nakai, Koji Ogawa, Rei Takeda, Masatsugu Ohara, Naoki Kawagishi, Takaaki Izumi, Machiko Umemura, Jun Ito, Takuya Sho, Goki Suda, Kenichi Morikawa, Naoya Sakamoto
AIM: Water retention, hepatic ascites, and peripheral edema are significant problems in patients with liver cirrhosis (LC). Although furosemide and spironolactone are commonly used as treatment, these are often insufficient to treat hyponatremia and renal insufficiency in patients with LC. Tolvaptan (TVP) could provide an effective treatment alternative. However, predictive factors of a therapeutic response to TVP are unclear. Our aim was to examine clinical predictors of the response to TVP in patients with LC and water retention...
October 6, 2017: Hepatology Research: the Official Journal of the Japan Society of Hepatology
https://www.readbyqxmd.com/read/28953058/albumin-use-in-patients-with-cirrhosis-in-france-results-of-the-albu-live-survey-a-case-for-better-easl-guidelines-diffusion-and-or-revision
#4
Armand Garioud, Jean-François Cadranel, Arnaud Pauwels, Jean-Baptiste Nousbaum, Thierry Thévenot, Thong Dao, Alexandre Louvet, Philippe Sogni, Nathalie Talbodec, Teresa M Antonini, Christophe Bureau, Dominique Thabut, Laure Elkrief, Vincent Jouannaud, Gilles Macaigne, Brigitte Bernard-Chabert, Hortensia Lison, Laurent Alric, Nicolas Carbonell, Héléne Labadie, Xavier Amiot, Armand Abergel, Bertrand Hanslik, Vincent Leroy, Victor De Lédinghen, Jacques Denis
INTRODUCTION: The use of human albumin for the management of cirrhosis has increased. Recommendations have been published for therapeutic paracentesis (TP), spontaneous bacterial peritonitis (SBP), and type 1 hepatorenal syndrome (HRS). The goal of this survey was to assess the prescription practices of French hepatogastroenterologists. METHODS: All hepatogastroenterologists were contacted. The questionnaire evaluated (1) the use of albumin in validated indications and (2) the prescription of albumin for nonvalidated clinical situations...
August 4, 2017: Journal of Clinical Gastroenterology
https://www.readbyqxmd.com/read/28943585/the-outcome-of-cirrhotic-patients-with-ascites-is-improved-by-the-normalization-of-the-serum-sodium-level-by-tolvaptan
#5
Tomomi Kogiso, Mutsuki Kobayashi, Kuniko Yamamoto, Yuichi Ikarashi, Kazuhisa Kodama, Makiko Taniai, Nobuyuki Torii, Etsuko Hashimoto, Katsutoshi Tokushige
Objectives Hyponatremia is frequently observed in patients with decompensated liver cirrhosis and it is also related to a poor prognosis. The vasopressin V2-receptor antagonist tolvaptan is used to treat cirrhotic patients with ascites and increases the serum sodium (Na) level. In this study, we investigated (i) whether or not correction of the Na level improves the prognosis of cirrhotic patients with ascites and (ii) predictors of normalization of the serum Na level after tolvaptan therapy. Methods This was a single-center retrospective study...
September 25, 2017: Internal Medicine
https://www.readbyqxmd.com/read/28895701/management-of-cirrhotic-ascites-in-children-review-and-recommendations-part-2-electrolyte-disturbances-nonelectrolyte-disturbances-therapeutic-options
#6
David F Bes, M Cristina Fernández, Ivone Malla, Horacio A Repetto, Daniel Buamscha, Susana López, Roxana Martinitto, Miriam Cuarterolo, Fernando Alvarez
Ascites is a major complication of cirrhosis. There are several evidence-based articles and guidelines for the management of adults, but few data have been published in relation to children. In the case of a pediatric patient with cirrhotic ascites (PPCA), the following questions are raised: How are the clinical assessment and ancillary tests performed? When is ascites considered refractory? How is it treated? Should fresh plasma and platelets be infused before abdominal paracentesis to prevent bleeding? What are the hospitalization criteria? What are the indicated treatments? What complications can patients develop? When and how should hyponatremia be treated? What are the diagnostic criteria for spontaneous bacterial peritonitis? How is it treated? What is hepatorenal syndrome? How is it treated? When should albumin be infused? When should fluid intake be restricted? The recommendations made here are based on pathophysiology and suggest the preferred approach to diagnostic and therapeutic aspects, and preventive care...
October 1, 2017: Archivos Argentinos de Pediatría
https://www.readbyqxmd.com/read/28836115/management-of-ascites-and-hepatorenal-syndrome
#7
REVIEW
Salvatore Piano, Marta Tonon, Paolo Angeli
Ascites represents the most common decompensating event in patients with liver cirrhosis. The appearance of ascites is strongly related to portal hypertension, which leads to splanchnic arterial vasodilation, reduction of the effective circulating volume, activation of endogenous vasoconstrictor systems, and avid sodium and water retention in the kidneys. Bacterial translocation further worsens hemodynamic alterations of patients with cirrhosis and ascites. The first-line treatment of uncomplicated ascites is a moderate sodium-restricted diet combined with diuretic treatment...
August 23, 2017: Hepatology International
https://www.readbyqxmd.com/read/28812111/syndrome-of-inappropriate-anti-diuresis-induces-volume-dependent-hypercalciuria
#8
J Grellier, A Jaafar, A Martin, M El Alaoui, C Lebely, I Tack, M Vallet
Hyponatremia is associated with bone demineralization. We hypothesized that, during hyponatremia, calciuria and calcium balance depend on volemic status. We evaluated calciuria in patients with hyponatremia, secondary to SIAD or hypovolemia. Patients with SIAD exhibited a volemic expansion that was associated with hypercalciuria. Calciuria was proportional to markers of volemia. INTRODUCTION: Chronic mild hyponatremia has been associated with bone demineralization of unknown mechanisms...
November 2017: Osteoporosis International
https://www.readbyqxmd.com/read/28812008/evaluation-of-adrenal-function-in-nonhospitalized-patients-with-cirrhosis
#9
Maryam Moini, Mitra Yazdani Sarvestani, Mesbah Shams, Masood Nomovi
BACKGROUND: Patients with cirrhosis and advancing hepatic insufficiency may show various degrees of other organ malfunction, including brain, kidney, and lung. Several studies have also shown a high prevalence of adrenal insufficiency in cirrhotic patients that may cause hemodynamic instability. MATERIALS AND METHODS: In this study we prospectively evaluated adrenal function in a population of nonhospitalized cirrhotic patients. Categorization of liver disease severity was done according to model for end-stage liver disease (MELD) score...
2017: Canadian Journal of Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/28806046/electrolytes-sodium-disorders
#10
REVIEW
Michael M Braun, Megan Mahowald
Sodium disorders (ie, hyponatremia, hypernatremia) are common electrolyte disturbances in clinical medicine and are associated with increased rates of morbidity and mortality. Etiologies of hyponatremia are classified into four categories. The first is pseudohyponatremia, in which the sodium level is low due to hyperproteinemia, hyperlipidemia, or hyperglycemia. The other three categories are based on overall patient fluid status and include hypovolemic (commonly due to fluid loss), hypervolemic (commonly due to fluid retention from heart failure, cirrhosis, or renal failure), and euvolemic (most often because of syndrome of inappropriate secretion of antidiuretic hormone)...
August 2017: FP Essentials
https://www.readbyqxmd.com/read/28764217/performance-of-disease-specific-scoring-models-in-intensive-care-patients-with-severe-liver-diseases
#11
Maged T El-Ghannam, Moataz H Hassanien, Mohamed D El-Talkawy, Abdel Aziz A Saleem, Amal I Sabry, Hoda M Abu Taleb
INTRODUCTION: Egypt has the highest prevalence of Hepatitis C Virus (HCV) in the world, estimated nationally at 14.7%. HCV treatment consumes 20% ($80 million) of Egypt's annual health budget. Outcomes of cirrhotic patients admitted to the ICU may, in fact, largely depend on differences in the state of the disease, criteria and indications for admission, resource utilization, and intensity of treatment. AIM: The aim of the present study was to evaluate the efficacy of liver specific scoring models in predicting the outcome of critically ill cirrhotic patients in the ICU as it may help in prioritization of high risk patients and preservation of ICU resources...
June 2017: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28737869/management-of-cirrhotic-ascites-in-children-review-and-recommendations-part-1-pathophysiology-diagnostic-evaluation-hospitalization-criteria-treatment-nutritional-management
#12
REVIEW
David F Bes, M Cristina Fernández, Ivone Malla, Horacio A Repetto, Daniel Buamsch, Susana López, Roxana Martinitto, Miriam Cuarterolo, Fernando Álvarez
Ascites is a major complication of cirrhosis. There are several evidence-based articles and guidelines for the management of adults, but few data have been published in relation to children. In the case of pediatric patients with cirrhotic ascites (PPCA), the following questions are raised: How are the clinical assessment and ancillary tests performed? When is ascites considered refractory? How is it treated? Should fresh plasma and platelets be infused before abdominal paracentesis to prevent bleeding? What are the hospitalization criteria? What are the indicated treatments? What complications can patients develop? When and how should hyponatremia be treated? What are the diagnostic criteria for spontaneous bacterial peritonitis? How is it treated? What is hepatorenal syndrome? How is it treated? When should albumin be infused? When should fluid intake be restricted? The recommendations made here are based on pathophysiology and suggest the preferred approach to its diagnostic and therapeutic aspects, and preventive care...
August 1, 2017: Archivos Argentinos de Pediatría
https://www.readbyqxmd.com/read/28725324/cardiorenal-syndrome-role-of-arginine-vasopressin-and-vaptans-in-heart-failure
#13
REVIEW
Poornima Vinod, Vinod Krishnappa, Abigail M Chauvin, Anshika Khare, Rupesh Raina
Heart and kidney failure continued to be of increasing prevalence in today's society, and their comorbidity has synergistic effect on the morbidity and mortality of patients. Cardiorenal syndrome (CRS) is a complex disease with multifactorial pathophysiology. Better understanding of this pathophysiological network is crucial for the successful intervention to prevent advancement of the disease process. One of the major factors in this process is neurohormonal activation, predominantly involving renin-angiotensin-aldosterone system (RAAS) and arginine vasopressin (AVP)...
June 2017: Cardiology Research
https://www.readbyqxmd.com/read/28722461/-disorders-of-water-and-electrolyte-metabolism-and-changes-in-acid-base-balance-in-patients-with-ascitic-liver-cirrhosis
#14
Halima Gottfriedová, Miroslava Horáčková, Milena Čáslavská, Julius Špičák, Otto Schück
In patients with advanced cirrhosis with ascites disorders of water and electrolyte metabolism are often present and they are associated with changes in acid-base balance. These changes can be very complicated, their diagnosis and treatment difficult. Dilutional hyponatremia is the most common disorder. Hyponatremia in these patients is associated with increased morbidity and mortality before and after liver transplantation. Other common disorders include hyperchloremic acidosis, hypokalemia, metabolic alkalosis, lactic acidosis, respiratory alkalosis...
2017: Casopís Lékar̆ů C̆eských
https://www.readbyqxmd.com/read/28608260/water-electrolyte-acid-base-and-trace-elements-alterations-in-cirrhotic-patients
#15
REVIEW
Carlos G Musso, Rossina Juarez, Richard J Glassock
Chronic hepatic patients, and particularly those suffering from cirrhosis, are predisposed to different sort of water, electrolyte, acid-base, and trace elements disorders due to their altered liver function, and also to their exposition to infectious, inflammatory, oncologic, and pharmacologic variables whose combination undermines their homeostatic capability. Hyponatremia, hypokalemia, hyperkalemia, hypocalcemia, metabolic acidosis, respiratory, and metabolic alkalosis are the main internal milieu alterations in this group...
June 12, 2017: International Urology and Nephrology
https://www.readbyqxmd.com/read/28533908/ascites-refractory-ascites-and-hyponatremia-in-cirrhosis
#16
Brett Fortune, Andres Cardenas
Ascites is the most common complication related to cirrhosis and is associated with increased morbidity and mortality. Ascites is a consequence of the loss of compensatory mechanisms to maintain the overall effective arterial blood volume due to worsening splanchnic arterial vasodilation as a result of clinically significant portal hypertension. In order to maintain effective arterial blood volume, vasoconstrictor and antinatriuretic pathways are activated, which increase overall sodium and fluid retention...
May 2017: Gastroenterology Report
https://www.readbyqxmd.com/read/28515029/tolvaptan-utilization-in-children-with-chronic-hyponatremia-due-to-inappropriate-antidiuretic-hormone-secretion-siadh-three-case-reports-and-review-of-the-literature
#17
Gerdi Tuli, Daniele Tessaris, Luisa De Sanctis, Patrizia Matarazzo
Hyponatremia is the most common electrolyte disorder among hospitalized patients and it is sometimes considered as a poor outcome predictor. Its correction is thus indicated, even in asymptomatic patients. The conventional treatment is represented by fluid restriction in presence of euvolemia or hypervolemia; whereas loop diuretics are used in some hypervolemic conditions (cardiac heart failure, liver cirrhosis and nephrotic syndrome) and intravenous isotonic or hypertonic solution are administered in hypovolemic conditions...
May 17, 2017: Journal of Clinical Research in Pediatric Endocrinology
https://www.readbyqxmd.com/read/28501971/electrolyte-and-acid-base-disturbances-in-end-stage-liver-disease-a-physiopathological-approach
#18
REVIEW
José Víctor Jiménez, Diego Luis Carrillo-Pérez, Rodrigo Rosado-Canto, Ignacio García-Juárez, Aldo Torre, David Kershenobich, Eduardo Carrillo-Maravilla
Electrolyte and acid-base disturbances are frequent in patients with end-stage liver disease; the underlying physiopathological mechanisms are often complex and represent a diagnostic and therapeutic challenge to the physician. Usually, these disorders do not develop in compensated cirrhotic patients, but with the onset of the classic complications of cirrhosis such as ascites, renal failure, spontaneous bacterial peritonitis and variceal bleeding, multiple electrolyte, and acid-base disturbances emerge. Hyponatremia parallels ascites formation and is a well-known trigger of hepatic encephalopathy; its management in this particular population poses a risky challenge due to the high susceptibility of cirrhotic patients to osmotic demyelination...
August 2017: Digestive Diseases and Sciences
https://www.readbyqxmd.com/read/28487868/severe-symptomatic-acute-hyponatremia-in-traumatic-brain-injury-responded-very-rapidly-to-a-single-15-mg-dose-of-oral-tolvaptan-a-mayo-clinic-health-system-hospital-experience-need-for-caution-with-tolvaptan-in-younger-patients-with-preserved-renal-function
#19
Macaulay Amechi Chukwukadibia Onuigbo, Nneoma Agbasi
Tolvaptan is now well established as a potent pharmaceutical agent for symptomatic hyponatremia from syndrome of inappropriate antidiuretic hormone secretion (SIADH), congestive heart failure and liver cirrhosis. Previous studies had recruited older (63-65 years) patients with mild renal impairment (serum creatinine, 1.3-1.4 mg/dl). A 2012 report in the Journal of Neurology, Neurosurgery & Psychiatry described tolvaptan as a "lifesaving drug". A major outcome concern in the treatment of chronic hyponatremia is potentially fatal pontine demyelination from over-rapid correction of serum sodium >0...
2017: Journal of Renal Injury Prevention
https://www.readbyqxmd.com/read/28362879/prediction-of-diuretic-response-to-tolvaptan-by-a-simple-readily-available-spot-urine-na-k-ratio
#20
Yasuyuki Komiyama, Masayuki Kurosaki, Hiroyuki Nakanishi, Yuka Takahashi, Jun Itakura, Yutaka Yasui, Nobuharu Tamaki, Hitomi Takada, Mayu Higuchi, Tomoyuki Gotou, Youhei Kubota, Kenta Takaura, Tsuguru Hayashi, Wann Oh, Mao Okada, Nobuyuki Enomoto, Namiki Izumi
BACKGROUND: Tolvaptan is vasopressin type 2 receptor antagonist that inhibits water reabsorption. It is used in combination with standard diuretics to treat ascites unresponsive to standard diuretic therapy or hyponatremia because of liver cirrhosis. This study evaluated the effectiveness and safety of tolvaptan in clinical practice and aimed to determine the factors related to its effectiveness. METHODS: Tolvaptan was administered to 88 consecutive cirrhotic patients with ascites unresponsive to standard diuretic therapy...
2017: PloS One
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