Hyponatremia in patients with liver diseases: not just a cirrhosis-induced hemodynamic compromise

Abstract

Hyponatremia (Na(+) <135 mmol/l) is the most common electrolyte disorder. Cirrhosis represents a rather frequent cause of hyponatremia mainly due to systemic and splanchnic vasodilation resulting in decreased effective arterial blood volume, which leads to excessive non-osmotic secretion of antidiuretic hormone. However, hyponatremia of multifactorial origin may be seen in patients with liver diseases. The review focuses on the factors and pathogenetic mechanisms of decreased sodium levels other than the hemodynamic compromise of cirrhosis in patients with liver diseases. The mechanisms and causal or contributing role of pseudohyponatremia, hyperglycemia, infections, drugs and toxins as well as of endocrine disorders, renal failure and cardiac disease in patients with liver disease are meticulously discussed. Hyponatremia of multifactorial origin is frequently observed in patients with liver diseases, and special efforts should be made to delineate the underlying causative and precipitating factors as well as the risk factors of the osmotic demyelination syndrome in order to properly manage this serious electrolyte disorder and avoid treatment pitfalls.

Coronary artery bypass graft combined with liver transplantation in patients with advanced alcoholic liver cirrhosis: A case report

“…End-stage liver disease leads to a number of complications (13,14), and blood loss is often high; heavy heparinization during coronary artery bypass grafting will exacerbate the risk of bleeding (15). Hypoproteinemia also causes poor nutritional status and poor tissue healing ability (16), and coronary artery bypass surgery wounds can easily become infected and lead to secondary sternal osteomyelitis (17). Systemic tissue edema and pleural effusion can cause a decrease in respiratory function, and pleural breakage may be difficult to repair due to thoracotomy and internal mammary artery incision (18).…”

A retrospective analysis of hyponatremia during terlipressin treatment in patients with esophageal or gastric variceal bleeding due to portal hypertension

“…As a result of decompensated liver cirrhosis portal vein pressure, vasopressin release may be increased, leading to the speculation that, in patients with decompensated cirrhosis of the liver, endogenous vasopressin preconditioning may be present due to the increase in endogenous vasopressin occupying the V2 receptor or renal collecting duct and the decrease in AQP‐2 expression, weakening the antidiuretic effect . In addition, it is also believed that the increase in urinary sodium caused by the activation of the V1 receptor by terlipressin is also a cause of hyponatremia . The mechanism remains to be elucidated.…”

Hyponatremia in Patients with Hematologic Diseases

“…Hepatitis B and C viruses (HBV and HCV) are common infections in patients with hemoglobinopathies, such as thalassemias, due to repetitive transfusions [34,35]. These infections have been associated with nephrotic-syndrome-or cholestasis-related hyperlipidemia as well as hypergammaglobulinemia due to chronic liver disease; thus, pseudohyponatremia may occur [36,37]. Monoclonal gammopathy and intravenous immunoglobulin (IVIG) administration have also been associated with spurious hyponatremia [38,39].…”