Chronic liver failure
ICD-10 K72.1 · ICD-11 DB99.8

Treatment of Chronic Liver Failure in Cirrhosis with Hypervolaemic Hyponatraemia

This protocol addresses patients with chronic liver failure in the context of liver cirrhosis who present with hypervolaemic hyponatraemia — a serum sodium below 130 mmol/L — accompanied by ascites and peripheral oedema.

Clinical scenario: Liver cirrhosis complicated by hypervolaemic hyponatraemia (serum Na <130 mmol/L). The predominant pattern is an expansion of the extracellular fluid volume, manifest as ascites and oedema — the more common form of dilutional hyponatraemia seen in advanced cirrhosis.
Treatment approach (partial)
A specific intravenous osmotic intervention is reserved for the rare cases in which life-threatening complications are present. When it is used, sodium correction must proceed gradually to prevent serious neurological harm.
Full regimen, sequencing, and criteria are available in the structured protocol →
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References

The second, most common, is characterised by an expansion of the extracellular fluid volume, with ascites and oedema.

The use of hypertonic saline in the management of hypervolemic hyponatremia should be limited to the rare cases presenting with life threatening complications. It could also be considered in patients with severe hyponatremia who are expected to get LT within a few days. The correction of serum sodium concentration, once an attenuation of symptoms has been obtained, should be slow (≤8 mmol/L per day) to avoid irreversible neurological sequelae, such as osmotic demyelination (II-3;1).

DOI: 10.1016/j.jhep.2018.03.024

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