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Hyponatremia in Patients with Cirrhosis of the Liver

Department of Clinical and Surgical Sciences, Alma Mater Studiorum—University of Bologna, 40139 Bologna, Italy
Semeiotica Medica, Policlinico S. Orosla-Malpighi, Via Albertoni, 15, 40138 Bologna, Italy
Author to whom correspondence should be addressed.
Academic Editor: Lewis S. Blevins
J. Clin. Med. 2015, 4(1), 85-101;
Received: 22 October 2014 / Accepted: 18 December 2014 / Published: 31 December 2014
(This article belongs to the Special Issue Hyponatremia: Advances in Diagnosis and Management)
Hyponatremia is common in cirrhosis. It mostly occurs in an advanced stage of the disease and is associated with complications and increased mortality. Either hypovolemic or, more commonly, hypervolemic hyponatremia can be seen in cirrhosis. Impaired renal sodium handling due to renal hypoperfusion and increased arginine-vasopressin secretion secondary to reduced effective volemia due to peripheral arterial vasodilation represent the main mechanisms leading to dilutional hyponatremia in this setting. Patients with cirrhosis usually develop slowly progressing hyponatremia. In different clinical contexts, it is associated with neurological manifestations due to increased brain water content, where the intensity is often magnified by concomitant hyperammonemia leading to hepatic encephalopathy. Severe hyponatremia requiring hypertonic saline infusion is rare in cirrhosis. The management of asymptomatic or mildly symptomatic hyponatremia mainly rely on the identification and treatment of precipitating factors. However, sustained resolution of hyponatremia is often difficult to achieve. V2 receptor blockade by Vaptans is certainly effective, but their long-term safety, especially when associated to diuretics given to control ascites, has not been established as yet. As in other conditions, a rapid correction of long-standing hyponatremia can lead to irreversible brain damage. The liver transplant setting represents a condition at high risk for the occurrence of such complications. View Full-Text
Keywords: hyponatremia; liver cirrhosis; hepatic encephalopathy; liver transplantation; Vaptans hyponatremia; liver cirrhosis; hepatic encephalopathy; liver transplantation; Vaptans
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Bernardi, M.; Ricci, C.S.; Santi, L. Hyponatremia in Patients with Cirrhosis of the Liver. J. Clin. Med. 2015, 4, 85-101.

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