Pathophysiology of ascites and dilutional hyponatremia: Contemporary use of aquaretic agents
Ascites, the most common complication of cirrhosis, is associated with a poor quality of life, an increased risk of infection, and renal failure. Twenty percent of cirrhotic patients have ascites at the time of diagnosis, while 30% and 50% will develop ascites by 5 and 10 years, respectively. There...
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2007-10-01
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doaj-3caf50df2a634db3b521a6102769fa9a2021-06-09T05:56:18ZengElsevierAnnals of Hepatology1665-26812007-10-0164214221Pathophysiology of ascites and dilutional hyponatremia: Contemporary use of aquaretic agentsJorge García Leiva0Julio Martínez Salgado1Jose Estradas2Aldo Torre3Misael Uribe4Department of Gastroenterology, Instituto Nacional de Ciencias Medicas y Nutrición Salvador ZubiránDepartment of Gastroenterology, Instituto Nacional de Ciencias Medicas y Nutrición Salvador ZubiránDepartment of Gastroenterology, Instituto Nacional de Ciencias Medicas y Nutrición Salvador ZubiránAddress for correspondence:; Department of Gastroenterology, Instituto Nacional de Ciencias Medicas y Nutrición Salvador ZubiránDepartment of Gastroenterology, Instituto Nacional de Ciencias Medicas y Nutrición Salvador ZubiránAscites, the most common complication of cirrhosis, is associated with a poor quality of life, an increased risk of infection, and renal failure. Twenty percent of cirrhotic patients have ascites at the time of diagnosis, while 30% and 50% will develop ascites by 5 and 10 years, respectively. There are several factors that contribute to ascites formation in cirrhotic patients, these include splanchnic vasodilatation, arterial hypotension, high cardiac output, and decreased vascular resistance. These factors lead to ineffective intravascular volume (hyperdynamic state), impairment of renal function, and subsequent water and sodium retention, all of which lead to dilutional hyponatremia (serum sodium <130 mEq/L), one of the most important prognostic factors in these patients. In conclusion, the therapeutic objective is to improve sodium balance and circulatory function through non-pharmacological measures, such as dietary sodium and water restriction as well as bed rest. Spironolactone (100-400 mg/day) is the initial drug of choice, while loop diuretics (like furosemide, 40-60 mg/day) are frequently used as adjuvants. Recently, agents that interfere with the renal effects of vasopressin by inhibiting water reabsorption in collecting ducts and producing free water diuresis have been used. These agents are called aquaretics and can be useful in the treatment of ascites unresponsive to conventional therapy.http://www.sciencedirect.com/science/article/pii/S1665268119319015Ascitesdilutional hyponatremia pathophysiologyaquaretics |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Jorge García Leiva Julio Martínez Salgado Jose Estradas Aldo Torre Misael Uribe |
spellingShingle |
Jorge García Leiva Julio Martínez Salgado Jose Estradas Aldo Torre Misael Uribe Pathophysiology of ascites and dilutional hyponatremia: Contemporary use of aquaretic agents Annals of Hepatology Ascites dilutional hyponatremia pathophysiology aquaretics |
author_facet |
Jorge García Leiva Julio Martínez Salgado Jose Estradas Aldo Torre Misael Uribe |
author_sort |
Jorge García Leiva |
title |
Pathophysiology of ascites and dilutional hyponatremia: Contemporary use of aquaretic agents |
title_short |
Pathophysiology of ascites and dilutional hyponatremia: Contemporary use of aquaretic agents |
title_full |
Pathophysiology of ascites and dilutional hyponatremia: Contemporary use of aquaretic agents |
title_fullStr |
Pathophysiology of ascites and dilutional hyponatremia: Contemporary use of aquaretic agents |
title_full_unstemmed |
Pathophysiology of ascites and dilutional hyponatremia: Contemporary use of aquaretic agents |
title_sort |
pathophysiology of ascites and dilutional hyponatremia: contemporary use of aquaretic agents |
publisher |
Elsevier |
series |
Annals of Hepatology |
issn |
1665-2681 |
publishDate |
2007-10-01 |
description |
Ascites, the most common complication of cirrhosis, is associated with a poor quality of life, an increased risk of infection, and renal failure. Twenty percent of cirrhotic patients have ascites at the time of diagnosis, while 30% and 50% will develop ascites by 5 and 10 years, respectively. There are several factors that contribute to ascites formation in cirrhotic patients, these include splanchnic vasodilatation, arterial hypotension, high cardiac output, and decreased vascular resistance. These factors lead to ineffective intravascular volume (hyperdynamic state), impairment of renal function, and subsequent water and sodium retention, all of which lead to dilutional hyponatremia (serum sodium <130 mEq/L), one of the most important prognostic factors in these patients. In conclusion, the therapeutic objective is to improve sodium balance and circulatory function through non-pharmacological measures, such as dietary sodium and water restriction as well as bed rest. Spironolactone (100-400 mg/day) is the initial drug of choice, while loop diuretics (like furosemide, 40-60 mg/day) are frequently used as adjuvants. Recently, agents that interfere with the renal effects of vasopressin by inhibiting water reabsorption in collecting ducts and producing free water diuresis have been used. These agents are called aquaretics and can be useful in the treatment of ascites unresponsive to conventional therapy. |
topic |
Ascites dilutional hyponatremia pathophysiology aquaretics |
url |
http://www.sciencedirect.com/science/article/pii/S1665268119319015 |
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