Water, electrolyte, acid–base, and trace elements alterations in cirrhotic patients

Musso, Carlos G.; Juarez, Rossina; Glassock, Richard J.

doi:10.1007/s11255-017-1614-y

Cited by 14 publications

(5 citation statements)

References 49 publications

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“…Abnormalities in serum electrolyte levels often complicate cirrhosis [1]. Serum sodium has long been considered as an important electrolyte prognostic marker [2,3].…”

Section: Introductionmentioning

confidence: 99%

Lower serum chloride concentrations are associated with increased risk of mortality in critically ill cirrhotic patients: an analysis of the MIMIC-III database

2021

BMC Gastroenterol

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Background Cirrhosis can be complicated by electrolyte abnormalities, but the major focus has been concentrated on the clinical significance of serum sodium levels. Emerging studies have identified hypochloremia as an independent prognostic marker in patients with chronic heart failure and chronic kidney disease. The aim of this study was to investigate whether serum chloride levels were associated with mortality of critically ill cirrhotic patients. Methods Critically ill cirrhotic patients were identified from the Multi-parameter Intelligent Monitoring in Intensive Care III Database. The primary outcome was ICU mortality. Logistic regression was used to explore the association between serum chloride levels and ICU mortality. The area under the receiver operating characteristic curves (AUC) was used to assess the performance of serum chloride levels for predicting ICU mortality. Results A total of 1216 critically ill cirrhotic patients were enrolled in this study. The overall ICU mortality rate was 18.8%. Patients with hypochloremia had a higher ICU mortality than those with non-hypochloremia (34.2% vs. 15.8%; p < 0.001). After multivariable risk adjustment for age, gender, ethnicity, chloride, sodium, Model for End-stage Liver Disease score, Sequential Organ Failure Assessment score, Elixhauser comorbidity index, mechanical ventilation, vasopressors, renal replacement therapy, acute kidney injury, hemoglobin, platelet, and white blood cell, serum chloride levels remained independently associated with ICU mortality (OR 0.94; 95% CI 0.91–0.98; p = 0.002) in contrast to serum sodium levels, which were no longer significant (OR 1.03; 95% CI 0.99–1.08; p = 0.119). The AUC of serum chloride levels (AUC, 0.600; 95% CI 0.556–0.643) for ICU mortality was statistically higher than that of serum sodium levels (AUC, 0.544; 95% CI 0.499–0.590) (p < 0.001). Conclusions In critically ill cirrhotic patients, serum chloride levels are independently and inversely associated with ICU mortality, thus highlighting the prognostic role of serum chloride levels which are largely overlooked.

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“…Abnormalities in serum electrolyte levels often complicate cirrhosis [1]. Serum sodium has long been considered as an important electrolyte prognostic marker [2,3].…”

Section: Introductionmentioning

confidence: 99%

Lower serum chloride concentrations are associated with increased risk of mortality in critically ill cirrhotic patients: an analysis of the MIMIC-III database

2021

BMC Gastroenterol

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“…In some literatures, blood transfusion is also considered as the factor which is due to the use of preservations. 21…”

Section: Discussionmentioning

confidence: 99%

Association of various risk factors with hypocalcemia in decompensated liver disease of viral origin.

Khan

Hameed

et al. 2022

TPMJ

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Objective: To determine the association of various factors with hypocalcaemia in individuals with decompensated cirrhosis with chronic viral hepatitis etiology. Study Design: Cross Sectional Observational Study. Setting: Department of Internal Medicine, Nishtar Medical University and Hospital Multan. Period: Six Months Extending from July, 2019 to December, 2019. Material & Methods: Sample Size: One hundred and seventy six patients were selected. Results: Among 176 study cases, 97 (55.1%) were male patients while 79 (44.9%) were females. Mean age of our study cases was noted to be 48.85 ± 8.13 years. Of these 176 study cases, 70 (39.7%) were from rural and 106 (60.3%) were urban background. Out of them, 124 (70.5%) were from poor families and remaining 52(29.5%) were middle class. Mean serum calcium level calculated was found to be 7.24 ± 0.87 mg/dl. Hypocalcemia was noted in 152 (86.4%) of our cases. It was seen that there was significant association among gender and hypocalcemia (p-value 0.000), poor socioeconomic status and hypocalcemia (p-value 0.014), obesity and hypocalcemia (p-value 0.009), duration of disease and hypocalcemia (p-value 0.001) treatment status and hypocalcemia (p-value 0.001), viral type with hypocalcemia (p-value 0.000). However no significant relation was discovered among hypocalcemia and age of patient and residential status of patients. Conclusion: We have noticed a very high distribution of hypocalcemia among decompensated cirrhotic having chronic viral hepatitis etiology. We also discovered that hypocalcemia had significant association with female sex, low socioeconomic fragment of society, longer duration of disease, untreated patients and hepatitis C related cirrhosis.

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“…Finally, malnutrition-associated chronic conditions (advanced heart failure, cirrhosis, AIDS, etc.) or malnutrition itself, through its inflammatory status, could also induce hyponatremia [11,[15][16][17].…”

Section: Hyponatremia In Malnutrition: Its Pathophysiology 1 Altered ...mentioning

confidence: 99%

Hyponatremia and malnutrition: a comprehensive review

Baez,

Chirio,

Pisula

et al. 2023

Ir J Med Sci

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Background Hyponatremia (serum sodium lower than 135 mmol/L) is the most frequent electrolyte alteration diagnosed in medical practice. It has deleterious clinical effects, being an independent predictor of mortality. Malnutrition encompasses pathological states caused by both nutrients excess and deficiency, being frequently documented in chronic kidney disease patients. In addition, chronic hyponatremia promotes adiposity loss and sarcopenia, while malnutrition can induce hyponatremia. This pathological interaction is mediated by four main mechanisms: altered electrolyte body composition (low sodium, low potassium, low phosphorus, or high-water body content), systemic inflammation (cytokines increase), hormonal mechanisms (renin–angiotensin–aldosterone system activation, vasopressin release), and anorexia (primary or secondary). Conclusion Malnutrition can induce hyponatremia through hydro-electrolytic, hormonal, inflammatory, or nutritional behavior changes; while hyponatremia per se can induce malnutrition, so there is a pathophysiological feedback between both conditions.

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Water, electrolyte, acid–base, and trace elements alterations in cirrhotic patients

Cited by 14 publications

References 49 publications

Lower serum chloride concentrations are associated with increased risk of mortality in critically ill cirrhotic patients: an analysis of the MIMIC-III database

Lower serum chloride concentrations are associated with increased risk of mortality in critically ill cirrhotic patients: an analysis of the MIMIC-III database

Association of various risk factors with hypocalcemia in decompensated liver disease of viral origin.

Hyponatremia and malnutrition: a comprehensive review

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