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Hyponatremia liver failure

Kerri McGreal, Pooja Budhiraja, Nishank Jain, Alan S L Yu
BACKGROUND: Hyponatremia is a common electrolyte imbalance that clinicians face on a regular basis. SUMMARY: This review aims to discuss four current challenges that can arise when diagnosing and treating hyponatremia: low solute intake, heart failure, exercise-associated hyponatremia, and mild chronic hyponatremia. Low solute intake in a person who already has a urinary concentrating defect will lead to increased retention of free water. The free water retention will cause or worsen hyponatremia that is already present...
June 2016: Kidney Diseases
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)
G Liamis, T D Filippatos, A Liontos, M S Elisaf
Hyponatremia (Na(+) <135 mmol/l) is the most common electrolyte disorder. Cirrhosis represents a rather frequent cause of hyponatremia mainly due to systemic and splanchnic vasodilation resulting in decreased effective arterial blood volume, which leads to excessive non-osmotic secretion of antidiuretic hormone. However, hyponatremia of multifactorial origin may be seen in patients with liver diseases. The review focuses on the factors and pathogenetic mechanisms of decreased sodium levels other than the hemodynamic compromise of cirrhosis in patients with liver diseases...
September 2016: Hepatology International
Domenico Scrutinio, Andrea Passantino, Pietro Guida, Enrico Ammirati, Fabrizio Oliva, Simona Sarzi Braga, Maria Teresa La Rovere, Rocco Lagioia, Maria Frigerio
BACKGROUND: To assess the impact of comorbidities on long-term all-cause mortality in patients hospitalized with exacerbated signs/symptoms of previously chronic stable HF (AE-CHF). METHODS: 1119 patients admitted for AE-CHF and with NT-proBNP levels >900pg/mL were enrolled. Univariable and multivariable Cox analyses were performed to assess the association of age, gender, hypertension, diabetes, obesity, atrial fibrillation, coronary heart disease (CHD), chronic obstructive pulmonary disease, previous cerebrovascular accidents, chronic liver disease (CLD), thyroid disease, renal impairment (RI), and anemia with 3-year all-cause mortality...
June 1, 2016: European Journal of Internal Medicine
George Liamis, Theodosios D Filippatos, Moses S Elisaf
Thiazide-induced hyponatremia is one of the main causes of decreased sodium levels in elderly individuals. This review presents the current evidence regarding the thiazide-associated hyponatremia. Thiazide-associated hyponatremia is observed mainly in patients with certain risk factors such as those receiving large doses of thiazides, having much comorbidity, such as heart failure, liver disease or malignancy, and taking several medications, such as non-steroidal anti-inflammatory drugs, selective serotonin re-uptake inhibitors or tricyclic antidepressants...
February 2016: Journal of Geriatric Cardiology: JGC
Qianqian Zhang, Xiaolin Guo, Shixing Zhao, Xiaoli Pang, Yang Wang, Yujiao Zhang, Baorong Chi
The present study aimed to analyze the prognostic factors of acute-on-chronic liver failure (ACLF), with the perspective of an improved selection of optimal therapeutic schemes. A retrospective analysis was used to study 164 patients with ACLF hospitalized between 2010 and 2014 in a single center. Patients were divided into favorable and unfavorable groups, according to the treatment outcomes. General characteristics and clinical manifestations were analyzed to determine whether they would affect the prognosis of the patients with ACLF, with a particular focus on the scoring systems Child-Pugh, model for end-stage liver disease (MELD), MELD with incorporation of sodium (MELD-Na), MELD and serum sodium ratio (MESO) and integrated MELD (iMELD)...
April 2016: Experimental and Therapeutic Medicine
Tanja Vukićević, Maike Schulz, Dörte Faust, Enno Klussmann
Arginine-vasopressin (AVP) stimulates the redistribution of water channels, aquaporin-2 (AQP2) from intracellular vesicles into the plasma membrane of renal collecting duct principal cells. By this AVP directs 10% of the water reabsorption from the 170 L of primary urine that the human kidneys produce each day. This review discusses molecular mechanisms underlying the AVP-induced redistribution of AQP2; in particular, it provides an overview over the proteins participating in the control of its localization...
2016: Frontiers in Pharmacology
Sonja Vuč Ković, Katarina Savić Vujović, Dragana Srebro, Branislava Medić, Tatjana Ilic-Mostic
Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed for the treatment of pain, inflamation and fever. They are usually well tolerated in healthy persons, but in patients with risk factors (advanced age, renal impairment, heart failure, liver disease, concurrent medications with antihypertensive drugs), NSAIDs can induce serious renal adverse effects. They include sodium and water retention with edema, worsening of heart failure, hypertension, hyponatremia, hyperkalemia, acute kidney injury, chronic kidney disease, renal papillary necrosis and acute interstitial nephritis...
2016: Current Medicinal Chemistry
Ashraf Abd El-Khalik Barakat, Amna Ahmed Metwaly, Fatma Mohammad Nasr, Maged El-Ghannam, Mohamed Darwish El-Talkawy, Hoda Abu Taleb
INTRODUCTION: Hyponatremia is common in cirrhosis. The relationship between hyponatremia and severity of cirrhosis is evidenced by its close association with the occurrence of complications, the prevalence of hepatic encephalopathy, hepatorenal syndrome, spontaneous bacterial peritonitis, refectory ascites, and hepatic hydrothorax. The aim of this study was assess the impact of hyponatremia on the occurrence of both liver-related complications and the hemodynamic cardiovascular dysfunction...
October 2015: Electronic Physician
Haruki Fujisawa, Yoshihisa Sugimura, Hiroshi Takagi, Hiroyuki Mizoguchi, Hideyuki Takeuchi, Hisakazu Izumida, Kohtaro Nakashima, Hiroshi Ochiai, Seiji Takeuchi, Atsushi Kiyota, Kazuya Fukumoto, Shintaro Iwama, Yoshiko Takagishi, Yoshitaka Hayashi, Hiroshi Arima, Yukio Komatsu, Yoshiharu Murata, Yutaka Oiso
Hyponatremia is the most common clinical electrolyte disorder. Once thought to be asymptomatic in response to adaptation by the brain, recent evidence suggests that chronic hyponatremia may be linked to attention deficits, gait disturbances, risk of falls, and cognitive impairments. Such neurologic defects are associated with a reduction in quality of life and may be a significant cause of mortality. However, because underlying diseases such as adrenal insufficiency, heart failure, liver cirrhosis, and cancer may also affect brain function, the contribution of hyponatremia alone to neurologic manifestations and the underlying mechanisms remain unclear...
March 2016: Journal of the American Society of Nephrology: JASN
Guy Decaux, Fabrice Gankam Kengne, Bruno Couturier, Frédéric Vandergheynst, Wim Musch, Alain Soupart
Oral urea has been used in the past to treat various diseases like gastric ulcers, liver metastases, sickle cell disease, heart failure, brain oedema, glaucoma, Meniere disease, etc. We have demonstrated for years, the efficacy of urea to treat euvolemic (SIADH) or hypervolemic hyponatremia. We briefly describe the indications of urea use in symptomatic and paucisymptomatic hyponatremic patients. Urea is a non-toxic, cheap product, and protects against osmotic demyelinating syndrome (ODS) in experimental studies...
2014: Journal of Clinical Medicine
Ebru Ortac Ersoy, Dorina Rama, Özlem Ünal, Serap Sivri, Arzu Topeli
Glutaric aciduria (GTA) type II can be seen as late onset form with myopathic phenotype. We present a case of a 19-year old female with progressive muscle weakness was admitted in intensive care unit (ICU) with respiratory failure and acute renal failure. Patient was unconscious. Pupils were anisocoric and light reflex was absent. She had hepatomegaly. The laboratory results showed a glucose level of 70 mg/dl and the liver enzymes were high. The patient also had hyponatremia (117 mEq/L) and lactate level of 3...
2015: Respiratory Medicine Case Reports
Paul B Watkins, James H Lewis, Neil Kaplowitz, David H Alpers, Jaime D Blais, Dan M Smotzer, Holly Krasa, John Ouyang, Vicente E Torres, Frank S Czerwiec, Christopher A Zimmer
INTRODUCTION: Subjects with autosomal dominant polycystic kidney disease (ADPKD) who were taking tolvaptan experienced aminotransferase elevations more frequently than those on placebo in the TEMPO 3:4 (Tolvaptan Efficacy and Safety in Management of Autosomal Dominant Polycystic Kidney Disease and its Outcomes) clinical trial. METHODS: An independent, blinded, expert Hepatic Adjudication Committee re-examined data from TEMPO 3:4 and its open-label extension TEMPO 4:4, as well as from long-term (>14 months) non-ADPKD tolvaptan trials, using the 5-point Drug-Induced Liver Injury Network classification...
November 2015: Drug Safety: An International Journal of Medical Toxicology and Drug Experience
Antoine Braconnier, Laurence Vrigneaud, Jean-Philippe Bertocchio
Hyponatremia could be defined as a public health topic: too many patients are concerned in both hospitalized and general populations; hyponatremia induces lots of clinical outcomes and a great economic burden. Its pathophysiology involves thirst regulation (hypotonic water intakes) and losses regulation (through the kidney under vasopressin control). Diagnostic approach should insure that hyponatremia reflects hypo-osmolality and hypotonicity: first, a false hyponatremia should be ruled out, then a non-hypotonic one...
July 2015: Néphrologie & Thérapeutique
Julie Steen Pedersen, Flemming Bendtsen, Søren Møller
The most common complication to chronic liver failure is ascites. The formation of ascites in the cirrhotic patient is caused by a complex chain of pathophysiological events involving portal hypertension and progressive vascular dysfunction. Since ascites formation represents a hallmark in the natural history of chronic liver failure it predicts a poor outcome with a 50% mortality rate within 3 years. Patients with ascites are at high risk of developing complications such as spontaneous bacterial peritonitis, hyponatremia and progressive renal impairment...
May 2015: Therapeutic Advances in Chronic Disease
Hideo Ohuchi, Jun Negishi, Yosuke Hayama, Osamu Sasaki, Yuki Taniguchi, Kanae Noritake, Aya Miyazaki, Osamu Yamada
BACKGROUND: Serum uric acid (UA, mg/dl) levels associate with the pathophysiology and prognosis in patients with chronic heart failure. PURPOSE: To clarify the clinical significance of hyperuricemia (HUA, UA>7.0) in Fontan patients. METHODS AND RESULTS: We prospectively measured UA in 197 child and 102 adult Fontan patients and compared the results with the clinical variables, including hemodynamics, exercise capacity, and plasma levels of norepinephrine (NE) and brain natriuretic peptide, and unscheduled hospitalization (USH), including all-cause mortality...
April 1, 2015: International Journal of Cardiology
Hisae Yasuhara, Atsushi Imagawa, Nao Koike, Eijiro Ueta, Akihiro Matsumi, Hiroyuki Terasawa, Hiroyuki Sakae, Keiko Takeuchi, Manabu Fujihara, Hitomi Endo, Hideki Jinno, Akio Moriya, Hidenori Hata, Morihito Nakatsu, Masaharu Ando
A 66-year-old woman was admitted to our hospital with heartburn and liver dysfunction. She was diagnosed with advanced gastric cancer. After the initiation of chemotherapy with trastuzumab, capecitabine, and cisplatin, she developed hyponatremia and renal failure with renal salt-wasting syndrome (RSWS). She recovered from these conditions after infusion of hypertonic saline. A diagnosis of RSWS should be considered in patients with hyponatremia who receive cisplatin-based chemotherapy.
February 2015: Gan to Kagaku Ryoho. Cancer & Chemotherapy
Andrés Cárdenas, Elsa Solà, Ezequiel Rodríguez, Rogelio Barreto, Isabel Graupera, Marco Pavesi, Faouzi Saliba, Tania Mara Welzel, Javier Martinez-Gonzalez, Thierry Gustot, Mauro Bernardi, Vicente Arroyo, Pere Ginès
INTRODUCTION: Hyponatremia is a marker of poor prognosis in patients with cirrhosis. This analysis aimed to assess if hyponatremia also has prognostic value in patients with acute-on-chronic liver failure (ACLF), a syndrome characterized by acute decompensation of cirrhosis, organ failure(s) and high short-term mortality. METHODS: We performed an analysis of the Chronic Liver Failure Consortium CANONIC database in 1,341 consecutive patients admitted to 29 European centers with acute decompensation of cirrhosis (including ascites, gastrointestinal bleeding, hepatic encephalopathy, or bacterial infections, or any combination of these), both with and without associated ACLF (301 and 1,040 respectively)...
2014: Critical Care: the Official Journal of the Critical Care Forum
Thierry Thévenot, Christophe Bureau, Frédéric Oberti, Rodolphe Anty, Alexandre Louvet, Aurélie Plessier, Marika Rudler, Alexandra Heurgué-Berlot, Isabelle Rosa, Nathalie Talbodec, Thong Dao, Violaine Ozenne, Nicolas Carbonell, Xavier Causse, Odile Goria, Anne Minello, Victor De Ledinghen, Roland Amathieu, Hélène Barraud, Eric Nguyen-Khac, Claire Becker, Thierry Paupard, Danielle Botta-Fridlung, Naceur Abdelli, François Guillemot, Elisabeth Monnet, Vincent Di Martino
BACKGROUND & AIMS: Albumin infusion improves renal function and survival in cirrhotic patients with spontaneous bacterial peritonitis (SBP) but its efficacy in other types of infections remains unknown. We investigated this issue through a multicenter randomized controlled trial. METHODS: A total of 193 cirrhotic patients with a Child-Pugh score greater than 8 and sepsis unrelated to SBP were randomly assigned to receive antibiotics plus albumin (1.5 g/kg on day 1 and 1g/kg on day 3; albumin group [ALB]: n=96) or antibiotics alone (control group [CG]: n=97)...
April 2015: Journal of Hepatology
Manuel Romero-Gómez, Sara Montagnese, Rajiv Jalan
Hepatic encephalopathy in a hospitalized cirrhotic patient is associated with a high mortality rate and its presence adds further to the mortality of patients with acute-on-chronic liver failure (ACLF). The exact pathophysiological mechanisms of HE in this group of patients are unclear but hyperammonemia, systemic inflammation (including sepsis, bacterial translocation, and insulin resistance) and oxidative stress, modulated by glutaminase gene alteration, remain as key factors. Moreover, alcohol misuse, hyponatremia, renal insufficiency, and microbiota are actively explored...
February 2015: Journal of Hepatology
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