Electrolyte and circulatory changes in terminal liver failure - Commentary

Nine patients with severe liver failure due to hepatic cirrhosis or virus hepatitis developed profound hyponatraemia, often with azotaemia. In six patients depression of serum-sodium values was initiated or accelerated by paracentesis abdominis. IN four patients hyponatraemia could not be corrected by administering salt. The patients became thirsty and developed further oedema and in the two patients who were weighted there was a weight gain. IN two patients therapy seemed to hasten death. Eight patients showed hypotension with evidence of gross peripheral vasodilatation. In three patients intravenous noradrenaline increased the blood pressure and urinary volume. The patients eventually proved unresponsive to increasing doses of the drug. The changes were independent of organic renal disease and of gastrointestinal haemorrhage. In patients wit liver disease serum-sodium levels below 130 mEq/l must be regarded as serious and those below 125 mEq/l as ominous.