Hyponatremia in Liver Cirrhosis

Cheolmin Jang; Young Kul Jung

doi:10.4166/kjg.2018.72.2.74

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Jang and Jung: Hyponatremia in Liver Cirrhosis

Review Article

Korean J Gastroenterol 2018;72(2):74-78.

Published online: 4 October 2018

DOI: https://doi.org/10.4166/kjg.2018.72.2.74

Hyponatremia in Liver Cirrhosis

Cheolmin Jang, Young Kul Jung¹

Department of Internal Medicine, Korea Universty College of Medicine, Seoul, Korea

¹Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea

Correspondence to: Young Kul Jung, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Ansan Hospital, 123 Jeokgeum-ro, Danwon-gu, Ansan 15355, Korea. Tel: +82-31-412-7623, Fax: +82-31-412-5582, E-mail: 93cool@hanmail.net

Received 12 July 2018 Revised 28 July 2018 Accepted 30 July 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Hyponatremia is a commonly observed complication that is related to hypoalbuminemia and portal hypertension in patients with advanced liver cirrhosis. Hyponatremia in patients with liver cirrhosis is mostly dilutional hyponatremia and is defined when the serum sodium concentration is below 130 meq/L. The risk of complications increases significantly in cirrhotic patients with hyponatremia, which includes spontaneous bacterial peritonitis, hepatorenal syndrome, and hepatic encephalopathy. In addition, hyponatremia is associated with increased morbidity and mortality in patients with cirrhosis, and is an important prognostic factor before and after liver transplantation. The conventional therapies of hyponatremia are albumin infusion, fluid restriction and loop diuretics, but these are frequently ineffective. This review investigates the pathophysiology and various therapeutic modalities, including selective vasopressin receptor antagonists, for the management of hyponatremia in patients with liver cirrhosis.

Keywords: Hyponatremia, Liver cirrhosis, Hypertension portal, Antidiuretic hormone receptor antagonists

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Table 1.

Characteristics of Various Vaptans

	Tolvaptan	Lixivaptan	Satavaptan	Conivaptan
Receptor	V1a/V2-R	V2-R	V2-R	V2-R
Route	Oral	Oral	Oral	Oral
Half-life	6–8 hours	7–10 hours	14–17 hours	3.1–7.8 hours
Metabolism	Liver (CYP3A)	Liver (CYP3A)	Liver (CYP3A)	Liver (CYP3A)
Elimination	Feces	Feces	Feces	Feces
Dosage	15 mg/d (max. 60) for 30	10–400 mg/d	5–50 mg/d	20 mg/days (continuous
	days			infusion) for 30 days
Adverse Effect	Thirst, dry mouth, fatigure,	Thirst, hypotension,	Thirst, dry mouth	Injection site reaction,
	polyuria, polydipsia	hypernatremia		headache, thrst
Approvement	U.S.FDA for SIADH, CHF;			U.S.FDA for euvolemic and
	Japan PMDA for ascites;			hypervolemic hyponatremia
	CFDA for ascites

V1a, vasopressin 1a; V2-R, vasopressin 2-receptor; CYP3A, Cytochrome P450 3A; U.S.FDA, The Food and Drug Administration of United States; SIADH, the syndrome of inappropriate antidiuretic hormone secretion; CHF, chronic heart failure; Japan PMDA, Pharmaceuticals and Medical Devices Agency of Japan; CFDA, China Food and Drug Administration.

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