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Hyponatremia Cirrhosis

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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
#1
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
#2
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...
May 13, 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
#3
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
#4
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
https://www.readbyqxmd.com/read/28352627/treatment-of-cirrhosis-associated-hyponatremia-with-midodrine-and-octreotide
#5
Sharad Patel, Dai-Scott Nguyen, Anjay Rastogi, Minh-Kevin Nguyen, Minhtri K Nguyen
BACKGROUND: Hyponatremia in the setting of cirrhosis is a common electrolyte disorder with few therapeutic options. The free water retention is due to non-osmotic vasopressin secretion resulting from the cirrhosis-associated splanchnic vasodilatation. Therefore, vasoconstrictive therapy may correct this electrolyte abnormality. The aim of this study was to assess the efficacy of midodrine and octreotide as a therapeutic approach to increasing urinary electrolyte-free water clearance (EFWC) in the correction of cirrhosis-associated hyponatremia...
2017: Frontiers in Medicine
https://www.readbyqxmd.com/read/28125428/falls-in-patients-with-liver-cirrhosis
#6
Meric Yildirim
Health-related quality of life (HRQOL) has become an important outcome for patients with liver cirrhosis as the number of transplantation candidates increases by the progression of treatment strategies. Falls and fall-related injuries are common in patients with liver cirrhosis and negatively affect HRQOL. Many factors increase the risk for falls such as minimal hepatic encephalopathy, psychoactive drugs, muscle strength, autonomic dysfunction, hyponatremia, and sleep problems. It is important to understand the underlying mechanisms for falls in cirrhotic patients to prevent severe injuries such as fractures, decrease healthcare costs, and improve HRQOL...
January 24, 2017: Gastroenterology Nursing: the Official Journal of the Society of Gastroenterology Nurses and Associates
https://www.readbyqxmd.com/read/28051801/utility-and-safety-of-tolvaptan-in-cirrhotic-patients-with-hyponatremia-a-prospective-cohort-study
#7
MULTICENTER STUDY
Ji-Dong Jia, Wen Xie, Hui-Guo Ding, Hua Mao, Hui Guo, Yonggang Li, Xiaojin Wang, Jie-Fei Wang, Wei Lu, Cheng-Zhong Li, Yimin Mao, Gui-Qiang Wang, Yue-Qiu Gao, Bangmao Wang, Qin Zhang, Yan Ge, Vincent Wai-Sun Wong
Introduction and aim. Hyponatremia is common in patients with decompensated cirrhosis and is associated with increased mortality. Tolvaptan, a vasopressor V2 receptor antagonist, can increase free water excretion, but its efficacy and safety in cirrhotic patients remain unclear. MATERIAL AND METHODS: We studied the usage and safety of tolvaptan in cirrhotic patients in a real-life, non-randomized, multicenter prospective cohort study. Forty-nine cirrhotic patients with hyponatremia were treated with tolvaptan 15 mg daily, and 48 patients not treated with tolvaptan in the same period served as controls...
January 2017: Annals of Hepatology
https://www.readbyqxmd.com/read/28002032/hyponatremia-unfavourable-prognostic-factor-in-hepatic-cirrhosis
#8
Aurelia Enescu, F Petrescu, P Mitruţ, V Pădureanu, Octavia Ileana Petrescu, Valeria Carmen Albu, Andreea Larisa Moraru, Anca Ştefania Enescu
Hyponatremia is defined by a level of Na in serum below or equal to 136 mEq/L while in hepatic cirrhosis it is classically considered as relevant only at a level of Na below 130 mEq/L. Hyponatremia frequently occurs in patients with end-stage hepatic disease. The frequency and severity are variable but it has been estimated that it occurs with a frequency of 57% in hospitalized patients with cirrhosis and in those on waiting lists for hepatic transplants. Signs and symptoms of hyponatremia are related to dysfunctions of the central nervous system, due to migration of the water from intravascular space to the brain cells, resulting in the occurrence of cerebral edema...
December 1, 2016: Romanian Journal of Internal Medicine, Revue Roumaine de Médecine Interne
https://www.readbyqxmd.com/read/27987289/cryptococcemia-in-an-hiv-negative-patient-with-decompensated-liver-cirrhosis
#9
Manasa Kandula, Amar H Kelkar, Nicole Liberio, Meenakshy K Aiyer
BACKGROUND: Cryptococcal infections have been mostly associated with immunocompromised individuals, 80-90% of whom have been HIV-positive patients. Increasingly, cryptococcal infections are being reported in cirrhotic patients who are HIV-negative. The underlying immunologic defects in cirrhotic patients seem to play an important role in predisposing them to cryptococcosis and affecting their morbidity and mortality. CASE PRESENTATION: We present a case of disseminated cryptococcosis in an HIV-negative patient with underlying cirrhosis, who had rapid worsening of his hyponatremia with renal failure and was unable to recover, despite aggressive measures...
2016: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/27935926/hyponatremia-in-patients-with-community-acquired-pneumonia
#10
L Karki, B Thapa, M K Sah
INTRODUCTION: Community acquired pneumonia is one the frequent cause of hospital admissions. Whereas, hyponatremia is a common electrolyte abnormality in hospitalized patients and has been shown to be associated with considerable morbidity and mortality. We aim to studyt the association of hyponatremia with community acquired pneumonia in terms of morbidity and mortality. METHODS: A prospective observational hospital based study was conducted in a hospital for a year...
April 2016: JNMA; Journal of the Nepal Medical Association
https://www.readbyqxmd.com/read/27801493/hyponatremia-in-cirrhosis-risk-factors-and-prognostic-value
#11
Rym Ennaifer, Myriam Cheikh, Hayfa Romdhane, Rafika El Elj, Houda Ben Nejma, Wassila Bougassas, Najet Bel Hadj
Background Hyponatremia is the most common electrolyte abnormality encountered in cirrhotic patients. Recent studies have shown that hyponatremia was correlated with severity of cirrhosis and associated with increased risk of complications and mortality. However this relationship is still unclear. The aims of the present study were to search predictive factors for hyponatremia in cirrhosis and to assess its prognostic value. Methods We performed a retrospective study, including consecutive cirrhotic patients admitted to our department between January 2011 and April 2014...
May 2016: La Tunisie Médicale
https://www.readbyqxmd.com/read/27746291/limited-efficacy-of-tolvaptan-in-patients-with-cirrhosis-and-severe-hyponatremia-real-life-experience
#12
Elisa Pose, Elsa Solà, Salvatore Piano, Elisabetta Gola, Isabel Graupera, Mónica Guevara, Andrés Cárdenas, Paolo Angeli, Pere Ginès
BACKGROUND: Vaptans, vasopressin selective V2-receptor antagonists, represent the first pharmacologic approach to the treatment of hypervolemic hyponatremia in cirrhosis. However, information on the use of vaptans for patients with cirrhosis and hyponatremia in a real-life scenario is limited. Therefore, this study evaluated the effect of tolvaptan on serum sodium in patients with cirrhosis and severe hypervolemic hyponatremia. METHODS: Nine patients with cirrhosis and serum sodium ≤125 mEq/L were included...
March 2017: American Journal of Medicine
https://www.readbyqxmd.com/read/27586252/terlipressin-a-vasoactive-prodrug-recommended-in-hepatorenal-syndrome-is-an-agonist-of-human-v1-v2-and-v1b-receptors-implications-for-its-safety-profile
#13
Pascal H Colson, Anne Virsolvy, Philippe Gaudard, Azzouz Charrabi, Maithé Corbani, Maxime J Manière, Sylvain Richard, Gilles Guillon
Terlipressin is recommended as a gold standard to treat hepatorenal syndrome complicating liver cirrhosis. It is presented as a specific V1A receptor agonist, beyond its enzymatic conversion into lysine(8)-Vasopressin (LVP), able to counteract the splanchnic vasodilation. However, the complete pharmacological characterization of this drug with respect to the different vasopressin receptor subtypes is missing. We studied terlipressin intrinsic properties, focusing not only on V1A, but also on other vasopressin receptor subtypes...
August 29, 2016: Pharmacological Research: the Official Journal of the Italian Pharmacological Society
https://www.readbyqxmd.com/read/27571467/-ascites-and-acute-kidney-injury
#14
Salvatore Piano, Marta Tonon, Paolo Angeli
Ascites is the most common complication of cirrhosis. Ascites develops as a consequence of an abnormal splanchnic vasodilation with reduction of effecting circulating volume and activation of endogenous vasoconstrictors system causing salt and water retention. Patients with ascites have a high risk to develop further complications of cirrhosis such as hyponatremia, spontaneous bacterial peritonitis and acute kidney injury resulting in a poor survival. In recent years, new studies helped a better understanding of the pathophysiology of ascites and acute kidney injury in cirrhosis...
July 2016: Recenti Progressi in Medicina
https://www.readbyqxmd.com/read/27542610/incidence-of-hyponatremia-with-high-dose-trimethoprim-sulfamethoxazole-exposure
#15
Demetra Tsapepas, Mariana Chiles, Revekka Babayev, Maya K Rao, Manasvi Jaitly, David Salerno, Sumit Mohan
BACKGROUND: Trimethoprim-sulfamethoxazole (TMP-SMX) is a commonly prescribed antibiotic used at high doses for treatment of pneumocystis pneumonia and other infections. Trimethoprim is structurally related to the potassium-sparing diuretic amiloride and has been associated with hyperkalemia and hyponatremia through blocking of epithelial sodium channels in the distal nephron. The incidence of hyponatremia in hospitalized patients treated with high-dose TMP-SMX is unknown. METHODS: We performed a single-center retrospective chart review of all hospitalized patients who received high-dose TMP-SMX (n = 235) from January 2012 to July 2014...
December 2016: American Journal of Medicine
https://www.readbyqxmd.com/read/27405984/potential-effectiveness-of-tolvaptan-to-improve-ascites-unresponsive-to-standard-diuretics-and-overall-survival-in-patients-with-decompensated-liver-cirrhosis
#16
Tomoharu Yamada, Takamasa Ohki, Yuki Hayata, Yuki Karasawa, Satoshi Kawamura, Daisaku Ito, Kentaro Kojima, Michiharu Seki, Nobuo Toda, Kazumi Tagawa
BACKGROUND AND OBJECTIVE: After tolvaptan was approved for the treatment of cirrhosis patients with ascites, only a few studies have reported its efficacy in the real clinical setting, and no studies have reported its contribution to overall survival. This study clarified the clinical outcomes of tolvaptan treatment in terms of improving ascites unresponsive to standard diuretics (AUS) and overall survival. METHODS: We retrospectively enrolled 80 decompensated cirrhosis patients with AUS who were administered tolvaptan from October 2012 to December 2014...
October 2016: Clinical Drug Investigation
https://www.readbyqxmd.com/read/27399058/wernicke-encephalopathy-in-a-patient-with-liver-failure-clinical-case-report
#17
Pan Zhao, Yanling Zhao, Zhenman Wei, Jing Chen, Lilong Yan
Early recognition and diagnosis of Wernicke encephalopathy is pivotal for the prognosis of this medical emergency, especially in patients with liver failure which predisposes individuals to develop hepatic encephalopathy. For these patients, distinguishing between hepatic encephalopathy and Wernicke encephalopathy is a challenge in real-world clinical practice.A male patient with 21-year medical history of liver cirrhosis presented diarrhea and ascites. One month before this visit, he was noted to have poor appetite and progressive fatigue...
July 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27363974/treatment-for-cirrhotic-ascites
#18
REVIEW
Hideto Kawaratani, Hiroshi Fukui, Hitoshi Yoshiji
Common complications of decompensated liver cirrhosis are esophageal varices, hepatic encephalopathy and ascites. After the onset of complications, the prognosis worsens. In patients with ascites, the 5-year mortality rate is 44%. Furthermore, hyponatremia, spontaneous bacterial translocation and hepatorenal syndrome also greatly worsen the prognosis. Effective treatment of cirrhotic ascites improves the quality of life and survival rate. Recently, the newly produced diuretic, tolvaptan (vasopressin V2 receptor antagonist), was reported to be effective in the treatment of refractory ascites in liver cirrhosis; however, there has not been an associated positive effect on the prognosis...
July 1, 2016: Hepatology Research: the Official Journal of the Japan Society of Hepatology
https://www.readbyqxmd.com/read/27362549/influence-of-preoperative-sodium-concentration-on-outcome-of-patients-with-hepatitis-b-virus-cirrhosis-after-liver-transplantation
#19
Peijie Wang, Gang Huang, Ngalei Tam, Chenglin Wu, Shunjun Fu, Bridget P Hughes, Linwei Wu, Xiaoshun He
OBJECTIVES: Whether preoperative serum sodium concentration could influence post-transplant patients' prognosis remains controversial. The aim of this study was to evaluate the influence of patients' pretransplant sodium concentration on the prognosis after liver transplantation in a cohort of patients with hepatitis B virus-related cirrhosis. PATIENTS AND METHODS: Data derived from the Chinese Liver Transplantation Registry system from 1 January 2000 to 31 December 2011 were extracted...
October 2016: European Journal of Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/27353278/factors-contributing-to-the-development-of-overt-encephalopathy-in-liver-cirrhosis-patients
#20
Motoh Iwasa, Ryosuke Sugimoto, Rumi Mifuji-Moroka, Nagisa Hara, Kyoko Yoshikawa, Hideaki Tanaka, Akiko Eguchi, Norihiko Yamamoto, Kazushi Sugimoto, Yoshinao Kobayashi, Hiroshi Hasegawa, Yoshiyuki Takei
The aim of this study was to clarify the relationships among psychometric testing results, blood ammonia (NH3) levels, electrolyte abnormalities, and degree of inflammation, and their associations with the development of overt hepatic encephalopathy (HE) in liver cirrhosis (LC) patients. The relationships between covert HE and blood NH3, sodium (Na), and C-reactive protein (CRP) were examined in 40 LC patients. The effects of elevated NH3, hyponatremia, and elevated CRP on the development of overt HE were also investigated...
October 2016: Metabolic Brain Disease
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