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REVIEW
Amy A Yau, Florian Buchkremer
Hyponatremia is common in patients with liver disease and is associated with increased mortality, morbidity, and a reduced quality of life. In liver transplantation, the inclusion of hyponatremia in organ allocation scores has reduced waitlist mortality. Portal hypertension and the resulting lowering of the effective arterial blood volume are important pathogenetic factors, but in most patients with liver disease, hyponatremia is multifactorial. Treatment requires a multifaceted approach that tries to reduce electrolyte-free water intake, restore urinary dilution, and increase nonelectrolyte solute excretion...
March 2024: Adv Kidney Dis Health
#2
JOURNAL ARTICLE
Farshad Abedi, Batool Zarei, Sepideh Elyasi
PURPOSE: Nowadays, it is largely accepted that albumin should not be used in hypoalbuminemia or for nutritional purpose. The most discussed indication of albumin at present is the resuscitation in shock states, especially distributive shocks such as septic shock. The main evidence-based indication is also liver disease. In this review, we provided updated evidence-based instruction for definite and potential indications of albumin administration in clinical practice, with appropriate dosing and duration...
April 12, 2024: European Journal of Clinical Pharmacology
#3
JOURNAL ARTICLE
Xuan-Ji Li, Hui-Hui Meng
BACKGROUND: Cirrhosis is a common liver disease, and ascites is one of the common clinical conditions. However, the clinical manifestations of ascites combined with hyponatremia as a high-risk condition and its relationship to patient prognosis have not been fully studied. AIM: To explore the clinical manifestations, prognostic factors, and relationships of ascites with hyponatremia in patients with cirrhosis to provide better diagnostic and treatment strategies...
March 27, 2024: World Journal of Gastrointestinal Surgery
#4
RANDOMIZED CONTROLLED TRIAL
A Ashritha, Bikrant B Lal, Rajeev Khanna, Vikrant Sood, Arun K Sood, Seema Alam
OBJECTIVES: Midodrine, an oral α-1-adrenergic receptor agonist, counters arterial hypovolemia and reduces complications in adult patients with cirrhosis. This randomized controlled trial (RCT) aimed to assess the efficacy and safety of midodrine in preventing complications and improving survival in children with cirrhosis and ascites who are awaiting liver transplantation (LT). METHODS: This open-label RCT conducted from January 2022 to May 2023 included children under 18 years with cirrhosis and ascites...
February 2024: Journal of Pediatric Gastroenterology and Nutrition
#5
JOURNAL ARTICLE
Mohamed Khayata, Richard A Grimm, Brian P Griffin, Bo Xu
Infective endocarditis (IE) is common in patients with liver disease. Outcomes of IE in patients with liver disease are limited. We aimed to investigate IE outcomes in patients with variables associated with liver disease in the USA. We used the 2017 National Readmission Database to identify index admission of adults with IE, based on the International Classification of Disease, 10th revision codes. The primary outcome was 30-day readmission. Secondary outcomes were mortality and predictors of hospital readmission...
January 12, 2024: Angiology
#6
REVIEW
Karina Holm Friis, Karen Louise Thomsen, Wim Laleman, Sara Montagnese, Hendrik Vilstrup, Mette Munk Lauridsen
Transjugular intrahepatic portosystemic shunt (TIPS) is an established treatment for portal hypertension and its' complications in liver cirrhosis, yet the development of hepatic encephalopathy (HE) remains a significant concern. This review covers the reported incidence, risk factors, and management strategies for post-TIPS HE over the past decade. Incidence varies widely (7-61%), with factors like age, liver function, hyponatremia, and spontaneous portosystemic shunts influencing risk. Procedural aspects, including TIPS timing, indication, and stent characteristics, also contribute...
December 19, 2023: Journal of Clinical Medicine
#7
JOURNAL ARTICLE
Gerardo M Castillo, Yao Yao, Rebecca E Guerra, Han Jiang, Akiko Nishimoto-Ashfield, Alexander V Lyubimov, Joshua F Alfaro, Kali A Striker, Nikolay Buynov, Phillip Schwabl, Elijah M Bolotin
Cirrhosis is a liver disease that leads to increased intrahepatic resistance, portal hypertension (PH), and splanchnic hyperemia resulting in ascites, variceal bleeding, and hepatorenal syndrome. Terlipressin, a prodrug that converts to a short half-life vasopressin receptor 1 A (V1a) full agonist [8-Lys]-Vasopressin (LVP), is an intravenous treatment for PH complications, but hyponatremia and ischemic side effects require close monitoring. We developed PHIN-214 which converts into PHIN-156, a more biologically stable V1a partial agonist...
January 3, 2024: Biomedicine & Pharmacotherapy
#8
Cheolgu Hwang
Hyponatremia is a common electrolyte disorder requiring careful management to prevent severe complications. Osmotic demyelination syndrome (ODS) is a serious neurological disorder that can develop from rapid correction of hyponatremia. Herein, is a description of the case of a 61-year-old man with multiple risk factors, including alcoholism, hypokalemia, malnutrition, and alcoholic liver cirrhosis, who developed ODS despite adherence to the recommended correction rate for hyponatremia. The patient presented to the emergency department with generalized weakness, gait disturbance, and decreased muscle strength...
December 2023: Electrolyte & Blood Pressure: E & BP
#9
REVIEW
James F Crismale, Tonia Kim, Thomas D Schiano
Third-spacing of fluid is a common complication in hospitalized patients with decompensated cirrhosis. In addition to ascites, patients with advanced cirrhosis may develop significant peripheral edema, which may limit mobility and exacerbate debility and muscle wasting. Concomitant kidney failure and cardiac dysfunction may lead to worsening hypervolemia, which may ultimately result in pulmonary edema and respiratory compromise. Diuretic use in such patients may be limited by kidney dysfunction and electrolyte abnormalities, including hyponatremia and hypokalemia...
January 2024: Clinical Transplantation
#10
JOURNAL ARTICLE
Anand V Kulkarni, Asim Ahmed Zuberi, K Chaitanya, Harshitha Doolam, Santhosh Reddy, P K Lakshmi, Shubankar Godbole, Venishetty Shantan, Sowmya Iyengar, Manasa Alla, Mithun Sharma, D Nageshwar Reddy, P N Rao
BACKGROUND AND OBJECTIVES: Human albumin (HA) solution is currently recommended only for patients with spontaneous bacterial peritonitis (SBP) and acute kidney injury (AKI). However, its use in hospitalized patients is quite frequent. The objective was to compare the outcomes of patients receiving HA in recommended (Gr. A) vs. non-recommended (Gr. B) indications. METHODS: In this prospective study, consecutive hospitalized patients who received HA were included...
December 12, 2023: Indian Journal of Gastroenterology: Official Journal of the Indian Society of Gastroenterology
#11
JOURNAL ARTICLE
Durga Deorukhkar, Archana Sonawale, Aman Goyal, Kshitij Sonawale
Objective To investigate predictive biomarkers correlated with the onset of hepatorenal syndrome (HRS) in individuals with alcoholic liver cirrhosis using various factors, including age, sex, and laboratory indicators such as serum sodium, bilirubin, PT/INR, and albumin levels. Additionally, we sought to establish a correlation between the occurrence of hepatic encephalopathy (HE), spontaneous bacterial peritonitis (SBP), and the model for end-stage liver disease (MELD) score at the time of diagnosis and the development of HRS in cirrhotic patients...
October 2023: Curēus
#12
JOURNAL ARTICLE
Nathaniel E Miller, David Rushlow, Stephen K Stacey
Hyponatremia and hypernatremia are electrolyte disorders that can be associated with poor outcomes. Hyponatremia is considered mild when the sodium concentration is 130 to 134 mEq per L, moderate when 125 to 129 mEq per L, and severe when less than 125 mEq per L. Mild symptoms include nausea, vomiting, weakness, headache, and mild neurocognitive deficits. Severe symptoms of hyponatremia include delirium, confusion, impaired consciousness, ataxia, seizures, and, rarely, brain herniation and death. Patients with a sodium concentration of less than 125 mEq per L and severe symptoms require emergency infusions with 3% hypertonic saline...
November 2023: American Family Physician
#13
REVIEW
Ramesh Kumar, Sudheer Marrapu
Patients with liver cirrhosis are advised to limit their sodium consumption to control excessive fluid accumulation. Salt is the most common form in which sodium is consumed daily. Consequently, various recommendations urge patients to limit salt intake. However, there is a lack of consistency regarding salt restriction across the guidelines. Moreover, there is conflicting evidence regarding the efficacy of salt restriction in the treatment of ascites. Numerous studies have shown that there is no difference in ascites control between patients with restriction of salt intake and those without restriction...
October 27, 2023: World Journal of Hepatology
#14
JOURNAL ARTICLE
Toshiyuki Nakanishi, Satoko Tamaru, Taku Harada, Kenta Shukuya, Kazushi Yamasato, Jun Kataoka, Kohzoh Makita, Mori Nakai
Osmotic demyelination syndrome (ODS) occurs in patients with diabetes and hyponatremia. We herein report a case of ODS with chorea detected on serial magnetic resonance imaging (MRI), despite no prompt hyponatremia correction. A 74-year-old man with cirrhosis and uncontrolled type 2 diabetes developed an altered mental status and chorea during treatment for diabetic ketoacidosis (DKA). Despite no rapid sodium correction and normal initial brain MRI findings, serial MRI revealed ODS-related abnormalities. Clinicians should consider ODS in patients with DKA and a hyperosmolar hyperglycemic state displaying unconsciousness and neurological manifestations, including chorea, even without substantial changes in serum sodium levels...
October 20, 2023: Internal Medicine
#15
JOURNAL ARTICLE
Lorenz Balcar, Mattias Mandorfer, Virginia Hernández-Gea, Bogdan Procopet, Elias Laurin Meyer, Álvaro Giráldez, Lucio Amitrano, Candid Villanueva, Dominique Thabut, Luis Ibáñez Samaniego, Gilberto Silva-Junior, Javier Martinez, Joan Genescà, Christophe Bureau, Jonel Trebicka, Elba Llop Herrera, Wim Laleman, José María Palazón Azorín, Jose Castellote Alonso, Lise Lotte Gluud, Carlos Noronha Ferreira, Nuria Cañete, Manuel Rodríguez, Arnulf Ferlitsch, Jose Luis Mundi, Henning Grønbæk, Manuel Nicolas Hernandez Guerra, Romano Sassatelli, Alessandra Dell'Era, Marco Senzolo, Juan Gonzalez Abraldes, Manuel Romero-Gómez, Alexander Zipprich, Meritxell Casas, Helena Masnou, Massimo Primignani, Aleksander Krag, Frederik Nevens, Jose Luis Calleja, Christian Jansen, María Vega Catalina, Agustín Albillos, Marika Rudler, Edilmar Alvarado Tapias, Maria Anna Guardascione, Marcel Tantau, Rémy Schwarzer, Thomas Reiberger, Stig Borbjerg Laursen, Marta Lopez-Gomez, Alba Cachero, Alberto Ferrarese, Cristina Ripoll, Vincenzo La Mura, Jaime Bosch, Juan Carlos García-Pagán
BACKGROUND & AIMS: Pre-emptive transjugular intrahepatic portosystemic shunt (TIPS) is the treatment of choice for high-risk acute variceal bleeding (AVB; i.e., Child-Turcotte-Pugh [CTP] B8-9+active bleeding/C10-13). Nevertheless, some 'non-high-risk' patients have poor outcomes despite the combination of non-selective beta-blockers and endoscopic variceal ligation for secondary prophylaxis. We investigated prognostic factors for re-bleeding and mortality in 'non-high-risk' AVB to identify subgroups who may benefit from more potent treatments (i...
January 2024: Journal of Hepatology
#16
JOURNAL ARTICLE
Tae Hyung Kim, Hyung Joon Yim, Young Kul Jung, Do Seon Song, Eileen L Yoon, Hee Yeon Kim, Seong Hee Kang, Young Chang, Jeong-Ju Yoo, Baek Gyu Jun, Sung Won Lee, Jung Gil Park, Ji Won Park, Sung-Eun Kim, Tae Yeob Kim, Soung Won Jeong, Ki Tae Suk, Moon Young Kim, Sang Gyune Kim, Won Kim, Jae Young Jang, Jin Mo Yang, Dong Joon Kim
BACKGROUND & AIMS: Few studies have investigated the prognosis of patients with non-severe alcoholic hepatitis (Non-SAH). The study aimed to develop a new prognostic model for patients with especially Non-SAH. METHODS: We extracted 316 hospitalized patients with alcoholic cirrhosis without severe alcoholic hepatitis, defined as Maddrey's discriminant function score lower than 32, from the retrospective Korean Acute-on-Chronic Liver Failure (KACLiF) cohort to develop a new prognostic model (training set), and validated it in 419 patients from the prospective KACLiF cohort (validation set)...
October 13, 2023: Hepatology International
#17
REVIEW
Lu Chai, Zhe Li, Ting Wang, Ran Wang, Kanokwan Pinyopornpanish, Gang Cheng, Xingshun Qi
BACKGROUND AND AIMS: Tolvaptan has been approved for the management of cirrhosis-related complications according to the Japanese and Chinese practice guidelines, but not the European or American practice guidelines in view of FDA warning about its hepatotoxicity. This study aimed to systematically evaluate its efficacy and safety in cirrhosis. METHODS: The PubMed, EMBASE, and Cochrane library databases were searched to identify randomized controlled trials (RCTs) evaluating the efficacy and/or safety of tolvaptan in cirrhosis...
2023: Expert Review of Gastroenterology & Hepatology
#18
JOURNAL ARTICLE
Hanyun Tu, Rong Liu, Anni Zhang, Sufei Yang, Chengjiang Liu
BACKGROUND: Hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF) has been confirmed as a prevalent form of end-stage liver disease in people subjected to chronic HBV infection. However, there has been rare in-depth research on the risk factors for the mortality of HBV-ACLF. This study aimed at determining the risk factors for the mortality of HBV-ACLF. METHODS: The relevant research was selected from four electronic databases that have been published as of August 2023...
October 3, 2023: BMC Gastroenterology
#19
JOURNAL ARTICLE
Bahaaeldeen Ismail, Richard Charnigo, Syed Mohammad Ali, Baker Alkhairi, Karim Benrajab, Harjinder Singh, Fernando J Castro
OBJECTIVE: Octreotide could increase serum sodium in cirrhotics with hyponatremia by counteracting splanchnic vasodilation. Current supporting data is limited to case reports and series. The aim of the study is to assess the effect of octreotide on serum sodium in cirrhotic inpatients with hyponatremia compared with controls. METHODS: This is a retrospective study including adult inpatients with cirrhosis, admitted for ≥5 days with Na <133 at baseline...
September 11, 2023: European Journal of Gastroenterology & Hepatology
#20
JOURNAL ARTICLE
Jonel Trebicka, Guadalupe Garcia-Tsao
Albumin is the most abundant protein in the human body and is synthetized exclusively by the liver. Therefore, serum albumin levels are reduced in acute and/or chronic liver disease. In cirrhosis, low levels of albumin predict the outcome. In advanced cirrhosis, the quality of albumin is decreased due to high oxidative stress and a proinflammatory state. Therefore, the administration of i.v. albumin would seem to be of pathophysiological relevance and benefit. Yet, the questions that remain are who, when, how much, and how often...
August 7, 2023: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
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