Refractory Ascites: Modulation of Atrial Natriuretic Factor Unresponsiveness by Mannitol

Abstract

We have previously shown that unresponsiveness to atrial natriuretic factor is a marker of the severity of ascites. The tubular mechanisms are unknown, but it seems that increased reabsorption of sodium proximal to the main site of action of atrial natriuretic factor (i.e., the inner medullary collecting duct) plays an important role. We attempted to decrease the proximal reabsorption of sodium with mannitol in patients unresponsive to atrial natriuretic factor. The results of mannitol in such a group of patients has previously been conflicting. We studied 10 patients with massive, resistant ascites who were off diuretics and on a 20-mmol/day sodium diet for 7 days. Atrial natriuretic factor unresponsiveness was confirmed by failure of a 2-hr atrial natriuretic factor infusion to induce a natriuresis. The next day all patients received an infusion of 40 gm of mannitol and subsequently a combined infusion of mannitol and atrial natriuretic factor. Proximal reabsorption of sodium and water were evaluated by lithium clearance, and glomerular filtration rate and renal blood flow were evaluated by inulin clearance and p-aminohippurate clearances, respectively. Six patients responded to mannitol alone with an increased diuresis (from 39 +/- 7 to 148 +/- 35 ml/hr) and natriuresis (from 0.27 +/- 0.05 mmol/hr to 1.65 +/- 0.53 mmol/hr; p less than 0.05) (responders), whereas four did not (nonresponders). The combination of atrial natriuretic factor and mannitol induced a further significant increase in sodium excretion (3.28 +/- 0.68 mmol/hr) but not in urine excretion, compared with mannitol alone.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of intravenous mannitol in mobilization of resistant cirrhotic ascites

“…Moreover, the dose of mannitol administered in Abraham's study was only 12 g (compared with 30 g in this study). Dose-dependent increase in response to mannitol was also observed by Morali et al [19] when they used a high dose (80 g) of mannitol to produce diuresis and natriuresis in patients with refractory ascites, while the dose of mannitol used in Pamuk's study was 20 g compared with the dose (30 g) used in this study [17].…”

Blunted natriuretic response to low-dose brain natriuretic peptide infusion in nonazotemic cirrhotic patients with ascites and avid sodium retention

“… 20,[25][26][27][28][29][30]. It should be considered, however, that under conditions of low flow rates in the ascending limb of Henle's loop, as is expected to occur in our patient^,^' lithium might be reabsorbed in the loop of Henle.32 Data obtained with this method, therefore,…”

Effect of conventional diuretics versus conventional diuretics plus mannitol on electrolytes for the treatment of cirrhotic ascites

“…Alam MJ 1 , Ashraf MS 2 , Aktar MN 3 , Sharmin S 4 , Das DC 5 , Ferdoushi S 6 , Sarker MJA 7 Etiology of cirrhosis of liver are chronic hepatitis B, chronic hepatitis C, alcoholic hepatitis, drug induced hepatitis, NASH, autoimmune hepatitis, Wilson's disease & cryptogenic hepatitis. In our country common etiological causes of cirrhosis is chronic hepatitis B & chronic hepatitis C. Pathologically cirrhosis of liver may be de ned as degeneration of normal architecture of liver with appearance of nodules in the liver.…”

“…Among decompensated cirrhosis of liver, ascites is the commonest manifestation; only 50% patients survive for 2 years. 1 A cirrhotic patient treated with diuretics may develop electrolyte imbalance such as hyponatraemia, hypokalaemia etc. e condition of the patient may deteriorate due to electrolyte imbalance.…”