Jang Cheol Min, Jung Young Kul
Department of Internal Medicine, Korea Universty College of Medicine, Seoul, Korea.
Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea.
Korean J Gastroenterol. 2018 Aug 25;72(2):74-78. doi: 10.4166/kjg.2018.72.2.74.
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.
低钠血症是晚期肝硬化患者中常见的并发症，与低白蛋白血症和门静脉高压有关。肝硬化患者的低钠血症大多为稀释性低钠血症，当血清钠浓度低于130 mEq/L时即可确诊。肝硬化合并低钠血症患者的并发症风险显著增加，包括自发性细菌性腹膜炎、肝肾综合征和肝性脑病。此外，低钠血症与肝硬化患者的发病率和死亡率增加相关，并且是肝移植前后的重要预后因素。低钠血症的传统治疗方法包括输注白蛋白、限制液体摄入和使用袢利尿剂，但这些方法常常无效。本综述探讨了肝硬化患者低钠血症的病理生理学及包括选择性血管加压素受体拮抗剂在内的各种治疗方式。
