Spironolactone Diuresis in Patients with Cirrhosis and Ascites

Eggert, Ronald C.

doi:10.1136/bmj.4.5732.401

Cited by 68 publications

(21 citation statements)

References 11 publications

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“…If this dosage fails to induce natriuresis, it may be increased in a stepwise manner every 3 to 5 days to a maximum of 400 to 600 mg per day [16][17][18]. Such a regimen will result in natriuresis in approximately 50% of patients.…”

Section: Rational Approach To Management Of Ascitesmentioning

confidence: 95%

Management of Renal Complications of Liver Disease

Epstein

Pérez

Oster

1988

J Intensive Care Med

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Included among the most important renal complica tions of liver disease is progressive sodium retention leading to the formation of edema and ascites and the hepatorenal syndrome (HRS). When ascites is refractory to conventional treatment, the use of invasive proce dures such as reinfusion or dialytic ultrafiltration of as cites or the peritoneovenous shunt may be indicated. The possibility that continuous arteriovenous hemo filtration may be useful in removing fluid in patients who would not otherwise tolerate traditional hemodialysis has, because of its recent availability, been raised. Ther apy of HRS continues to be one of the most intriguing and vexing problems in clinical medicine. The use of hemodialysis with polyacrylonitrile membranes may be helpful in certain patients with HRS, especially in those with acute reversible liver injury. Although the peri toneovenous shunt has been reported to correct the renal functional disturbance, the results of the only two controlled studies available are inconclusive. Liver disease is frequently accompanied by a variety of alterations in renal function and electrolyte me tabolism [1]. These complications of liver disease range in severity from the clinically unimportant to problems requiring prompt and vigorous thera peutic intervention. In the present review, empha sis is placed on the management of the abnor malities of renal sodium handling and on acute intrinsic renal failure (ATN) and the hepatorenal syndrome (HRS), which often supervene in patients with severe liver disease. The reader is referred to Epstein [1,2] and Perez and colleagues [3] for more detailed expositions of the use of dialysis and ultrafiltration in treating renal complications of liver disease.

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Section: Rational Approach To Management Of Ascitesmentioning

confidence: 95%

Management of Renal Complications of Liver Disease

Epstein

Pérez

Oster

1988

J Intensive Care Med

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“…These observations of rapid initiation of di uresis by loop diuretics, however, cannot be construed to indicate that bumetanide is more effective than spironolactone. It is well known that the dose of spironolactone re quired to achieve a satisfactory therapeutic effect in cirrhosis with ascites varies from patient to patient, and may need to be step ped up to 1,000 mg/day [10]. A fixed-dose schedule, as was used in the present study, may not provide the maximum therapeutic efficacy of spironolactone.…”

Section: Discussionmentioning

confidence: 45%

“…This advantage should be remembered, keeping in mind the fact that the dose of spironolactone required to achieve a satisfactory therapeutic effect may go up to 1,000 mg/day [10]. While on a molar basis, bumetanide has been shown to be more potent than frusemide, there is little information available on the comparative efficacy of a combination of bumetanide and spironolactone, and frusemide and spirono lactone.…”

Section: Discussionmentioning

confidence: 99%

“…These are more marked with the potent loop diuretics furosemide [4] or bumetanide [1,3] than with spironolactone [8,10]. Total exchangeable potassium is low in cirrhotic patients.…”

Section: Discussionmentioning

confidence: 99%

“…The relatively poor re sponse seen with 200 mg/day of spironolac tone could be due to the slow onset of diuretic action. It is well known that it takes a few days (usually from 3 to 5 days) before the peak diuretic action of spironolactone is achieved [5,10], Most patients (76%) in our study had severe ascites; waiting for more than a week for necessary diuretic response (5 days of bed rest prior to starting treatment and a lag period of 3-5 days before adequate spironolactone action was achieved), either worsened the condition of some patients or failed to evoke a rapid and satisfactory re sponse. On the other hand, bumetanide alone or in combination with spironolac tone, was relatively more successful, possibly because it could initiate rapid diuresis.…”

Section: Discussionmentioning

confidence: 99%

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Bumetanide, Spironolactone and a Combination of the Two, in the Treatment of Ascites due to Liver Disease

Sarin

Sachdev²,

Mishra³

et al. 1988

Digestion

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There are few studies available comparing the efficacy of loop and distal diuretics and a combination of the two groups, in the treatment of ascites due to liver disease. Thirty-seven nonazotemic cirrhotic patients with ascites were randomly allocated to receive for 2 weeks bumetanide (group A, n = 13), spironolactone (group B, n = 12) or a combination of the two drugs (group C, n = 12) after a 5-day stabilization period. The response to the treatment was 69, 42 and 83% in groups A, B and C, respectively; the difference was not significant. Hypokalemia was seen in 4 patients of group A and mild hyperkalemia in 2 patients of group B. Electrolyte disturbances were minimal in patients of group C. The response to diuretic treatment was prompt in groups A and C. It can be concluded that a combination of loop and distal diuretics is superior to a one-drug regimen in achieving a rapid and better diuretic response with fewer side effects.

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An Effect of Spironolactone on Urinary Acidification in Normal Man

Manuel¹

1974

Arch Intern Med

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Spironolactone Diuresis in Patients with Cirrhosis and Ascites

Cited by 68 publications

References 11 publications

Management of Renal Complications of Liver Disease

Management of Renal Complications of Liver Disease

Bumetanide, Spironolactone and a Combination of the Two, in the Treatment of Ascites due to Liver Disease

An Effect of Spironolactone on Urinary Acidification in Normal Man

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