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Sodium excretion in advanced cirrhosis: Effect of expansion of central blood volume and suppression of plasma aldosterone
Author(s) -
Nicholls Kathleen M.,
Shapiro Michael D.,
Kluge Rudiger,
Chung HsaioMin,
Bichet Daniel G.,
Schrier Robert W.
Publication year - 1986
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.1840060213
Subject(s) - aldosterone , medicine , cirrhosis , plasma volume , endocrinology , sodium , blood volume , chemistry , organic chemistry
Sodium excretion in 13 patients with decompensated cirrhosis was measured under baseline conditions of water loading (n = 13) and during conditions designed to improve effective blood volume including: head‐out water immersion alone (n = 13); norepinephrine infusion alone (n = 6), and combined norepinephrine and head‐out water immersion (n = 6). All 13 patients were in positive sodium balance under baseline conditions, with a mean plasma aldosterone concentration of 78.7 ± 15.6 ng per dl. In only four patients was plasma aldosterone less than 50 ng per dl. During head‐out water immersion alone, 5 patients achieved negative sodium balance and, in all 5, plasma aldosterone was less than 50 ng per dl (mean = 23.0 ± 5.3 ng per dl). However, the mean plasma aldosterone during head‐out water immersion in the eight patients who remained in positive sodium balance during this maneuver was 64.0 ± 11.9 ng per dl (p < 0.01). During norepinephrine alone, positive sodium balance was maintained in all patients, and plasma aldosterone was not significantly different from baseline. Combining norepinephrine and head‐outwater immersion resulted in the largest and most consistent negative sodium balance. The mean plasma aldosterone concentration was decreased significantly (78.7 ± 15.6 to 32.6 ± 9.9) ng per dl (p < 0.05). Regardless of the maneuver performed, nopatient in whom aldosterone exceeded 50 ng per dl achieved negative sodium balance. Furthermore, only in those studies utilizing head‐out water immersion, with or without norepinephrine, was negative sodium balance seen. The results, therefore, suggest that expansion of central blood volume with suppression of plasma aldosterone overcomes sodium avidity in decompensated cirrhosis.