This prospective study was performed to evaluate the concentration of the serum sodium and its pathogenesis in 16 patients of liver cirrhosis without ascites and 8 patients with ascites who were admitted to Hanyang University Hospital from
November
1992
to January 1993.
In order to evaluate the pathogenesis of the hyponatremia, we measured the level of serum sodium, serum albumin, serum creatinine, creatinine clearance, 24-hour urinary sodium excretion, plasma renin ativity(PRA), aldosterone and sympathetic
activity in
cirrhotic patients without ascities(Group I, n=16) and with ascites(Group II, n=8). Serum Na level and excretion of Na in 24 hour urine were decreased significantly in patients with decompensated liver cirrhsosi(liver cirrhosis with
ascites)(P=0.006).
And the frequency of patients with hyponatremia was high in liver cirrhosis with ascites(Group I : 13%, Group II : 50%). The serum albumina and creatinine clearance were significantly decreased in liver cirrhosis with as cites(P=0.000, P=0.012).
The PRA
serum norepinephrine were also significantly increased in liver cirrhosis with ascites(P=0.000, P=0.018). During hospital 10 days, the serum sodium concentration was significantly more decreased(P=0.04, 136±1.9mEq/1132±2.6mEq/1) with
significant
weight loss and decreased creatinine clearance in liver cirrhosis with ascites. The serum concentration of sodium showed positive correlation with serum albumin(R=0.6, P=0.004) and negative correlation with PRA(R=0.7, P=0.001) in al patients with
liver
cirrhosis. These findings indicate that the hyponatremia in liver cirrhosis is associated with decreased creatinine clearance and disturbance of free water excretion due to hypoalbuminemia, decreased effective circulatory volume, increased PRA
and
increased sympathetic activity.(Korean J Gastroenterol 1994 ; 26 : 662-668)
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