Fluid retention in the body, such as ascites, is one of the major complications in chronic liver diseases such as chronic active hepatitis, cirrhosis of the liver and hepatoma due to the liver failure handling water and electrolytes when the treatment was not performed properly.
The electrolyte change and imbalance is one of important precipitating factors for the induction of hepatic encephalopathy. In management of ascites, the diuretics are used in general and it may cause electrolyte imbalance not infrequently which may elicit terminal events.
We determined the serum and urine electrolyte levels and observed their changes induced by administering various diuretics including soldactone® in 134 patients with chronic liver diseases who were admitted to and confirmed at the department of medicine, Seoul National University Hospital, during the recent 24 months period of time.
The results obtained are summarized as follows:
1. There was no significant difference in serum Na and K level between hepatoma, liver cirrhosis, chronic active hepatitis and control group, and also found was no difference between the groups with or without ascites.
2. Daily urinary Na output was low in patients with ascites as compared with those without ascites. It was very low in a group of chronic liver disease as compared with control group regaradless of presence of ascites.Therefore one can expect that the ascites formation is more likely when the daily urinary Na output decreased in the patients with chronic liver disease.
3. There was no significant difference in daily urinary K output between the patients with or without ascites in chronic liver disease. Furthermore, the daily urinary K output of the patients with out ascites was the same as in control group.
4. The diuretic effect of recently developed SoIdactone was superb to aldactone and in some cases to hydrochlorthiazide, but less effective than furosemide, and the onset of action was observed within the frst 24 hours of therapy which is significantly faster than aldactone. The medication is more easily controllable for it has no prolonged effects. There was no metabolic derangement observed such as hyperkalemia or hypokalemia even at the dose. of, 400mg daily for the duration of 5 weeks observed. It was safely recommended that Soldactone is the one which can be used in patients with decompensated chronic liver disease for comparatively long time of period without a great risk.
(The authors are greathy indebted to G.D. Seard Co., Ltd. who supplied Soldactone®.)
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