Treatment of Liver Cirrhosis in Hypervolaemic Hyponatraemia with Ascites
This protocol applies to patients with liver cirrhosis who present with hyponatraemia — serum sodium below 130 mmol/L — in the setting of fluid overload, ascites, and peripheral oedema.
Clinical situation
The condition is characterised by expansion of the extracellular fluid volume, manifesting as ascites and oedema. Correction requires attaining a negative water balance. Management must be calibrated to avoid overcorrection and its serious consequences.
Approach (partial)
Management involves fluid restriction. Albumin administration may also be considered. The full decision algorithm, thresholds, and sequencing are set out in the complete protocol.
Treatment goals
Prevent further reduction in serum sodium levels. Once symptoms attenuate, sodium correction must proceed at a controlled rate to avoid irreversible neurological sequelae.
References
DOI: 10.1016/j.jhep.2018.03.024
- The second, most common, is characterised by an expansion of the extracellular fluid volume, with ascites and oedema.
- The management of hypervolemic hyponatremia requires attainment of a negative water balance.
- Fluid restriction to 1,000 ml/day is recommended in the management of hypervolemic hyponatremia since it may prevent a further reduction in serum sodium levels (III;1).
- Albumin administration can be suggested in hypervolemic hyponatremia, but data are very limited to support its use (II-3;2).
- 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).
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