This protocol addresses liver cirrhosis patients with hypervolaemic hyponatraemia — serum sodium below 130 mmol/L — presenting with ascites and oedema. This form of hyponatraemia is characterised by expansion of the extracellular fluid volume. Its management requires attainment of a negative water balance.
First-line management — fluid restriction to 1,000 ml/day with albumin administration — aims to prevent a further reduction in serum sodium and, once symptoms are attenuated, to keep the daily rise no greater than 8 mmol/L per day. When these sodium targets are not met, escalation to the next protocol step is indicated.
When first-line management has not stabilised serum sodium, a hypertonic saline-based approach may be considered — but only in a tightly defined subset of patients.
After an initial rapid correction aimed at attenuating clinical symptoms (5 mmol/L in the first hour), serum sodium concentration should not increase more than 8 mmol/L per day.
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.
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.
In practice, after an initial rapid correction aimed at attenuating clinical symptoms (5 mmol/L in the first hour), serum sodium concentration should not increase more than 8 mmol/L per day.
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