Pseudohyponatremia in Acute Liver Disease

Vo, Hieu; Garcia-Rosell, Melinda; Wall, Barry M.; Gosmanov, Aidar R.

doi:10.1097/maj.0b013e3182703327

Cited by 17 publications

(13 citation statements)

References 10 publications

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“…This association has been confirmed by published data [4][5][6] . It is however necessary to rule out, pseudohyponatremia in acute on chronic liver failure 21 . Data on the actual prognostic value of serum sodium are relatively controversial.…”

Section: Discussionmentioning

confidence: 99%

Predictors of hepatorenal syndrome in alcoholic liver cirrhosis

Janíčko¹,

Veselíny²,

Senajová³

et al. 2015

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Background. Alcoholic liver disease is a major cause of liver cirrhosis and the hepatorenal syndrome is a serious complication. Risk factors for hepatorenal syndrome (HRS) in alcoholic liver cirrhosis are not entirely explored. Aim. To assess the risk factors for hepatorenal syndrome in alcoholic liver cirrhosis. Patients and Methods. Consecutive patients with alcoholic liver disease were followed for two months, development of renal failure, classified either as HRS or renal failure not fulfilling criteria of HRS, was the main outcome. Results. Of 171 patients, 14 (8.2%) developed HRS and 13 (7.6%), renal failure not fulfilling the HRS criteria. A significant difference was found between patients with and without HRS in serum sodium (131.1±3.8 vs. 135.7±5.2; P = 0.003), creatinine, (94.1±26.8 vs. 80.3±20.2; P < 0.001), albumin (23.5±4.9 vs. 29.9±5.8; P < 0.001), INR (1.76±0.45 vs. 1.44±0.41; P < 0.001), bilirubin (252.3±179.4 vs. 91.2±101.0; P < 0.001), MELD (23±6 vs 15±5; P < 0.001) and MELD-Na score (27±5 vs. 18±6; P < 0.001). Multivariate analysis adjusted for sex and age showed that sodium together with creatinine are the strongest HRS predictors, followed by bilirubin with respective odds´ ratios (95% CI) of 1.041 (1.012-1.072) for creatinine, 0.870 (0.766-0.988) for serum sodium and 1.005 (1.001-1.010) for serum bilirubin. Conclusion. Serum levels of sodium, creatinine and bilirubin are important predictors of the hepatorenal syndrome.

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Section: Discussionmentioning

confidence: 99%

Predictors of hepatorenal syndrome in alcoholic liver cirrhosis

Janíčko¹,

Veselíny²,

Senajová³

et al. 2015

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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“…The chemistry laboratory that measured the low plasma sodium level should be consulted to find out which method was used to measure the sodium level. Usually, it will be the commonly used indirect potentiometric technique in which the sample is diluted prior to measurement using an ion‐selective sodium electrode, a practice introduced to minimize the effect of the void volume on the measurement. Given that no adjustments or calibrations were made to the measurement and the concentration is expressed as the actual plasma water sodium concentration, a direct potentiometric method (without prior dilution of the sample) may aid to avoid the occurrence of spurious hyponatremia.…”

Section: Discussionmentioning

confidence: 99%

“…Given that no adjustments or calibrations were made to the measurement and the concentration is expressed as the actual plasma water sodium concentration, a direct potentiometric method (without prior dilution of the sample) may aid to avoid the occurrence of spurious hyponatremia. Spurious hyponatremia can also be identified if the plasma osmolality is normal or if hyponatremia is absent on repeat testing using a potentiometric method measuring the actual plasma water concentration without adjustment for assumed void volumes .…”

Section: Discussionmentioning

confidence: 99%

Osmotic Pressure in Clinical Medicine with an Emphasis on Dialysis

Raimann

Tzamaloukas

Levin

et al. 2016

Seminars in Dialysis

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Since the beginning of life of the first multicellular organisms, the preservation of a physiologic milieu for every cell in the organism has been a critical requirement. A particular range of osmolality of the body fluids is essential for the maintenance of cell volume. In humans the stability of electrolyte concentrations and their resulting osmolality in the body fluids is the consequence of complex interactions between cell membrane functions, hormonal control, thirst, and controlled kidney excretion of fluid and solutes. Knowledge of these mechanisms, of the biochemical principles of osmolality, and of the relevant situations occurring in disease is of importance to every physician. This comprehensive review summarizes the major facts on osmolality, its relation to electrolytes and other solutes, and its relevance in physiology and in disease states with a focus on dialysis-related considerations.

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“…HCV-or hepatitis B virus (HBV)-related nephrotic syndrome and glycogen storage disease may be accompanied by mixed dyslipidemia, whereas primary biliary cirrhosis or other cholestatic liver diseases may be associated with marked hypercholesterolemia attributed to accumulation of lipoprotein-X. Consequently, the above-mentioned liver diseases as well as the administration of intravenous immunoglobulin (e.g., in liver transplant patients) should be considered as potential causes of spurious hyponatremia [10,[12][13][14][15][16][17].…”

Section: Other Causes Of Hyponatremia In Patients With Liver Diseasesmentioning

confidence: 98%

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

et al. 2016

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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.

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Pseudohyponatremia in Acute Liver Disease

Cited by 17 publications

References 10 publications

Predictors of hepatorenal syndrome in alcoholic liver cirrhosis

Predictors of hepatorenal syndrome in alcoholic liver cirrhosis

Osmotic Pressure in Clinical Medicine with an Emphasis on Dialysis

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

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