[232] Albumin Infusion for Severe Hyponatremia in Patients With Refractory Ascites: A Randomized Clinical Trial

Jalan, R; Mookerjee, R.; Cheshire, Lisa; Williams, Robert H.; Davies, Nathan

doi:10.1016/s0168-8278(07)61830-3

Cited by 47 publications

(50 citation statements)

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“…Finally, albumin has been shown to improve serum sodium concentration in a few studies, but the number of patients included has been low, and the follow-up has been short. 35,36 …”

Section: Management Of Hyponatremiamentioning

confidence: 99%

Hyponatremia in cirrhosis: Pathogenesis, clinical significance, and management

Ginès¹,

Guevara²

2008

Hepatology

280

269

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Hyponatremia is a frequent complication of advanced cirrhosis related to an impairment in the renal capacity to eliminate solute-free water that causes a retention of water that is disproportionate to the retention of sodium, thus causing a reduction in serum sodium concentration and hypo-osmolality. The main pathogenic factor responsible for hyponatremia is a nonosmotic hypersecretion of arginine vasopressin (or antidiuretic hormone) from the neurohypophysis related to circulatory dysfunction. Hyponatremia in cirrhosis is associated with increased morbidity and mortality. There is evidence suggesting that hyponatremia may affect brain function and predispose to hepatic encephalopathy. Hyponatremia also represents a risk factor for liver transplantation as it is associated with increased frequency of complications and impaired short-term survival after transplantation. The current standard of care based on fluid restriction is unsatisfactory. Currently, a new family of drugs, known as vaptans, which act by antagonizing specifically the effects of arginine vasopressin on the V2 receptors located in the kidney tubules, is being evaluated for their role in the management of hyponatremia. The short-term treatment with vaptans is associated with a marked increase in renal solute-free water excretion and improvement of hyponatremia. Long-term administration of vaptans seems to be effective in maintaining the improvement of serum sodium concentration, but the available information is still limited. Treatment with vaptans represents a novel approach to improving serum sodium concentration in cirrhosis.

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“…Finally, albumin has been shown to improve serum sodium concentration in a few studies, but the number of patients included has been low, and the follow-up has been short. 35,36 …”

Section: Management Of Hyponatremiamentioning

confidence: 99%

Hyponatremia in cirrhosis: Pathogenesis, clinical significance, and management

Ginès¹,

Guevara²

2008

Hepatology

280

269

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“…The available data are limited and include a small number of patients with very short-term follow-up, but suggest a benefit that needs to be explored in larger, randomized trials. (21) A randomized pilot study in 24 patients admitted with serum sodium <130 mmol/L found that albumin significantly improved serum sodium levels, compared with matched controls treated with fluid restriction, with a mean increase of 9 mmol/L. There was also a significant increase, compared with controls, in free water clearance and serum vasopressin levels in patients treated with albumin.…”

Section: Hrs Typementioning

confidence: 99%

“…This finding suggests that albumin may contribute to the improvement of circulatory dysfunction and decrease the non-osmotic release of arginine vasopressin (AVP). (21) The introduction of a new drug class, termed 'vaptans', was heralded by excitement over their potential benefit in cirrhosis-related hyponatraemia. These medications act as direct antagonists of the V2 receptor in the collecting tubule of the nephron, and significantly increase free water clearance.…”

Section: Hrs Typementioning

confidence: 99%

Association between Serum Sodium Level and Severity of Complications in Liver Cirrhosis

Ibrahim¹

2017

jmscr

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“…5,8,31 Albumin infusion is also recommended for pediatric patients with a blood albumin level ≤ 2.5 g/dL to promote extravascular water reabsorption, associated with loop diuretics to produce more diuresis. 2,87 It has been observed that albumin infusion and water restriction correct HH in children, and other authors have proposed this treatment for adults, 88 but there are no good-quality studies to support this recommendation. 8,89 Albumin infusion alone or together with vasopressors may also be useful for the management of HH.…”

Section: Therapeutic Options Albumin Prescriptionmentioning

confidence: 99%

Management of cirrhotic ascites in children. Review and recommendations. Part 2: Electrolyte disturbances, nonelectrolyte disturbances, therapeutic options

et al. 2017

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Ascites is a major complication of cirrhosis. There are several evidence-based articles and guidelines for the management of adults, but few data have been published in relation to children. In the case of a pediatric patient with cirrhotic ascites (PPCA), the following questions are raised: How are the clinical assessment and ancillary tests performed? When is ascites considered refractory? How is it treated? Should fresh plasma and platelets be infused before abdominal paracentesis to prevent bleeding? What are the hospitalization criteria? What are the indicated treatments? What complications can patients develop? When and how should hyponatremia be treated? What are the diagnostic criteria for spontaneous bacterial peritonitis? How is it treated? What is hepatorenal syndrome? How is it treated? When should albumin be infused? When should fluid intake be restricted? The recommendations made here are based on pathophysiology and suggest the preferred approach to diagnostic and therapeutic aspects, and preventive care.

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[232] Albumin Infusion for Severe Hyponatremia in Patients With Refractory Ascites: A Randomized Clinical Trial

Cited by 47 publications

References 0 publications

Hyponatremia in cirrhosis: Pathogenesis, clinical significance, and management

Hyponatremia in cirrhosis: Pathogenesis, clinical significance, and management

Association between Serum Sodium Level and Severity of Complications in Liver Cirrhosis

Management of cirrhotic ascites in children. Review and recommendations. Part 2: Electrolyte disturbances, nonelectrolyte disturbances, therapeutic options

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