Interrelationship between cardiac output and vascular resistance as determinants of effective arterial blood volume in cirrhotic patients.

The effect of head-out water immersion (HWI) in decompensated cirrhotic patients to correct sodium and water excretion has been found to be incomplete and variable. The explanation may be that the efficacy of HWI in correcting a decreased effective arterial blood volume (EABV) in decompensated cirrhotic patients is limited by an accompanying decrease in systemic vascular resistance (SVR) and thus a relative increase in arterial vascular holding capacity. The present studies were undertaken to examine this possibility by maintaining SVR (dynes X sec X cm-5) nearly constant during HWI with an exogenous infusion of norepinephrine (HWI + NE). In six decompensated cirrhotic patients, neither HWI nor NE infusion alone significantly increased sodium excretion (UNaV, 13 vs. 19 and 13 microEq/min, respectively), but each maneuver increased the excretion of a 20 ml/kg water load (28 to 60 and 61%, respectively, both P less than 0.05). The combination of HWI + NE, however, significantly increased UNaV to 70 microEq/min (P less than 0.05) and percentage of water excretion to 95 (P less than 0.001), values significantly greater than those achieved with either maneuver alone. These differences were not explained by any changes in inulin clearance. With HWI alone, cardiac index (CI) increased (4.2 to 5.3 liter/min/m2, P less than 0.01), but SVR decreased (872 to 613 dynes X sec X cm-5, P less than 0.001) and mean arterial pressure (MAP) remained constant (83 vs. 78 mm Hg).(ABSTRACT TRUNCATED AT 250 WORDS)