An Insight to Hyponatremia in Cirrhosis: Pathophysiology and Management Approaches

Abstract

Cirrhosis is considered by systemic and splanchnic vasodilation that principals to extreme nonosmotic excretion of vasopressin. Hyponatremia is a mutual electrolyte irregularity in progressive liver disease that outcomes from the diminished capability of the kidney to excrete solute-free water that principals to “dilutional” hyponatremia water retention uneven to the retaining of sodium. Hyponatremia is mutual in cirrhosis. It frequently happens in a progressive phase of the disease and is related with problems and augmented mortality. Moreover, hypovolemic, or more usually, hypervolemic hyponatremia might be seen in cirrhosis. Diminished renal sodium treatment due to augmented arginine-vasopressin secretion and renal hypoperfusion secondary to condensed functioning volumia due to peripheral arterial vasodilation specify the chief mechanisms principal to dilutional hyponatremia in this setting. The foremost pathogenic influence responsible for hyponatremia is a nonosmotic hypersecretion of arginine vasopressin from the neurohypophysis associated to circulatory dysfunction. The treatment of choice for hypervolemic hyponatremia is fluid restraint. Vaptans, drugs that are selective antagonists of vasopressin V2 receptors, appeared as the first pharmacological treatment of hypervolemic hyponatremia in cirrhosis with auspicious results. Though, satavaptan was inhibited from expansion for safety reasons and tolvaptan is not suggested in patients with liver disease. Consequently, now there is no actual and safe pharmacological method accessible for the management of hypervolemic hyponatremia in cirrhosis. In this review we are going to highlight the pathophysiology and treatment methods.

Keywords: Hyponatremia, prognostic significance, diagnosis, vaptans, urea, κ-opioid agonists

Cite this Article

Asad Jamal Ansari, Mohammad Monawwar, Nishat Fatima, Mohd Imran, Shayna Bano, Mehtab Alam. An Insight to Hyponatremia in Cirrhosis: Pathophysiology and Management Approaches. Research & Reviews: A Journal of Immunology. 2020; 10(3): 30–46p.