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Query: UMLS:C0023890 (cirrhosis)
 42,195 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Grave hyperkalemic is a serious metabolic disorder. Its treatment fell into the fields of urgent medicine because of the risk of malignant cardiac arrhythmias that can be fatal for the patient. The article deals with the treatment of a 49-year-old female patient with decompensated liver cirrhosis and diabetes mellitus in whom grave hyperkalemia (9 mmol/1) with typical electrocardiographic changes was provoked by potassium saving diuretics combined with furosemide and the additional potassium substituted drugs, as well as development of diabetic ketoacidosis. Thanks to intensive medicinal treatment and constant follow-up of the patient rapid disappearance of hyperkalemia and ketoacidosis was observed. The success of medicinal therapy can be expected in cases of extreme hyperkalemia and relative hypokaliaemia. Intracellular hyperkaliaemia must be treated, without delay, with dialysis. Potassium saving diuretics and furosemide do not require additional potassium drugs, especially in risk patients in whom hyperkalemia may develop because of other existing diseases.
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PMID:[Treatment of extreme hyperkalemia caused by diabetic ketoacidosis, potassium-sparing diuretics and potassium substitutes]. 212 65

The effects of anaritide, a 25-amino-acid synthetic analogue of ANP, were evaluated in 28 patients with cirrhosis complicated by ascites and/or edema. Each patient received two doses of the agent, as well as an infusion of placebo. Six different doses were tested ranging from 0.015-0.300 microgram/kg/min. The infusions lasted for 2 hours and were flanked by both baseline and recovery periods. There was a significant effect of placebo on urinary sodium and chloride excretion rates but no effect on urine flow rate. In response to anaritide, the urine flow rate increased at 0.03, 0.06, 0.075, and 0.100 microgram/kg/min. The sodium and chloride excretion rates increased at all doses except the highest dose. There was no definite effect of anaritide on urinary potassium, calcium, and phosphate excretion rates. There was also no significant effect on creatinine clearance. The mean arterial pressure decreased in response to the 0.060, 0.075, and 0.100 microgram/kg/min doses. In addition, five of the patients receiving the highest dose (0.300 microgram/kg/min) had decreases in their systolic pressures to 90 mm Hg or less. In conclusion, anaritide is natriuretic and diuretic in patients with cirrhosis complicated by ascites and/or edema. Its effect, however, on arterial pressure may limit its therapeutic potential in this patient population.
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PMID:Renal and hemodynamic effects of atrial natriuretic peptide in patients with cirrhosis. 213 74

The ability of urine extracts to inhibit sodium and potassium-activated ATPase, cross-react with antidigoxin antibodies and induce natriuresis in rats was investigated in 10 healthy subjects, 10 cirrhotic patients without ascites (compensated cirrhotics), 27 nonazotemic cirrhotic patients with ascites and 10 cirrhotic patients with ascites and functional renal failure to assess whether reduced activity of natriuretic hormone contributes to sodium retention in cirrhosis. No significant differences were seen between healthy subjects and compensated cirrhotic patients in any of these parameters (sodium and potassium-activated ATPase inhibition = 178.5 +/- 19.8 vs. 247.4 +/- 48.7 nmol equivalent of ouabain/day; digoxinlike activity = 43.9 +/- 6.1 vs. 48.0 +/- 5.6 ng equivalent of digoxin/day; natriuretic activity = 0.36 +/- 0.15 vs. 0.63 +/- 0.27 mumol/min). Cirrhotic patients with ascites with and without functional renal failure showed significantly higher values of sodium and potassium-activated ATPase inhibition (708.1 +/- 94.0 and 529.2 +/- 53.9 nmol equivalent of ouabain/day, respectively), digoxinlike activity (136.9 +/- 7.2 and 116.3 +/- 7.9 ng equivalent of digoxin/day) and natriuretic activity (1.78 +/- 0.48 and 1.93 +/- 0.37 mumol/min) than healthy subjects and compensated cirrhotic patients. We saw no significant differences between these two groups of cirrhotic patients with ascites with respect to these parameters. In the cirrhotic patients studied, sodium and potassium-activated ATPase inhibition and antidigoxin antibodies directly correlated with the degree of impairment of hepatic and renal function, plasma renin activity and plasma levels of aldosterone and norepinephrine.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Natriuretic hormone activity in the urine of cirrhotic patients. 216 51

A review of the aldosterone antagonist spironolactone is presented. It is effective both as monotherapy and in combination with other hypotensive agents in the control of both essential and hyperaldosterone-induced hypertension. It is useful as a diuretic in conditions such as cirrhosis and congestive heart failure, and is most commonly employed because of its potassium- and magnesium-sparing qualities. Spironolactone also has been used as an antiandrogenic agent in managing hirsutism. Its adverse effect profile, considered somewhat prohibitive in the past, is generally not significant when reasonably low doses (less than 150 mg/d) are used.
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PMID:Spironolactone: a re-examination. 240 87

The development of hepatic encephalopathy and coma hepaticum in patients with acute gastrointestinal bleeding and hepatic cirrhosis is a serious problem. Since 1983 we perform a whole gut irrigation with mannite for cleansing the bowel via naso-gastric tube. The aim of this therapy is to reduce the severity of hepatic encephalopathy. The first 20 patients with the new therapeutic concept were compared with the last 20 patients with the prevailing therapy. We studied the effect of the new therapeutic concept as to reduction of hepatic encephalopathy and possible electrolyte loss. None of the patients in the mannite group had hepatic encephalopathy stage III or IV, whereas 75% of the patients without mannite showed clinical signs of stage III or IV. Serum potassium, sodium and chloride were not significantly different between both groups. In the group with mannite application no change in serum creatinine was observed, whereas in the other group a minute increase of serum creatinine was seen.
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PMID:[Orthograde intestinal irrigation with a mannitol solution in reducing hepatic encephalopathy in patients with liver cirrhosis and gastrointestinal hemorrhage]. 250 57

The circadian variations in atrial natriuretic peptide (ANP), plasma renin activity (PRA) and plasma aldosterone (PA) have been investigated in a group of 6 patients with compensated cirrhosis of the liver compared with a group of 6 healthy subjects. All studied subjects were kept for a week on standardized life conditions, with a defined daily intake of 120 mEq of sodium and 60 mEq of potassium. Venous blood samples were collected during a whole day at 6, 8, 12, 18, 20 and 24 hours, with the subjects resting in the clinostatic position during the study. Plasma levels of ANP, PRA and PA were determined by radioimmunoassay. The data were analyzed by the cosinor method. The results show that healthy subjects present a significant circadian rhythm for the three biological variables, while patients with cirrhosis of the liver present a significant rhythm for PA only. Acrophase and amplitude of PA do not present any difference between control and patient groups. The levels of PRA and ANP are significantly higher in the cirrhotic patients. These data suggest in cirrhosis a deep variation in the secreting rhythm of PRA and ANP with maintenance, even at higher levels, of intrinsic PA rhythm. This is a possible index of time-related alterations of water-electrolyte balance and cardiovascular processes in liver cirrhosis.
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PMID:[Circadian rhythm of atrial natriuretic peptide, plasma renin and aldosterone activity in healthy subjects and in patients with compensated liver cirrhosis]. 252 93

The relationship between adrenocorticotropic hormone as well as renin and potassium activity and blood aldosterone secretion was examined in normal subjects and patients with chronic hepatic diseases. It is demonstrated that aldosterone stimulation is controlled by simultaneous renin-angiotensin (RA) and hypothalamo-adenopituitary effects in normal subjects and patients with chronic active hepatitis (CAH), the RA effects prevailing in normal subjects, and hypothalamo-adenopituitary ones, in CAH patients. Cirrhosis of the liver was associated with the greatest deviations in the stimulant-aldosterone relationship. Viral cirrhosis with ascites featured a considerable RA increase, affecting the adrenals, while the contribution of ACTH was reduced considerably. ACTH level was the highest in patients with alcoholic cirrhosis.
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PMID:[Hormonal changes in chronic diffuse diseases of the liver]. 255 Oct 48

The pathogenetic role of ADH in determining hyponatremia in patients with liver cirrhosis is still much debated. Osmotic stimuli are not able to inhibit secretion of ADH in refractory ascites and under such conditions the reduction in effective plasma volume has been put forward as the main cause. Twenty patients with liver cirrhosis and refractory ascites were studied before and during extraction-concentration-reinfusion (ECR) of ascitic fluid by means of Rhodiascit. ADH, renin, aldosterone, blood and urine osmolarity, plasma and urinary concentration of sodium, potassium, chlorine, and the clearance of free water were evaluated. All patients presented high renin values (15.4 +/- 11.7 ng/ml), aldosterone (341 +/- 172 ng/ml), ADH (6.3 +/- 5.2 pg/ml). During ECR, a significant drop was observed in renin (p less than 0.001), aldosterone (p less than 0.001) urinary osmolarity (p less than 0.001) and an equality significant increase in diuresis (p less than 0.001), natriuria (p less than 0.005), kaliuria (p less than 0.001) while ADH presented an irregular course: in 11 cases it remained unchanged, in 3 it fell and in 6 it presented a constant increase. To conclude, data suggest that the diminished filtrate reaching the distal tubule constitutes the greatest cause of the inability to dilute urine in many patients with cirrhosis and that ADH is a permissive rather than a primary factor.
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PMID:[Changes in antidiuretic hormone (ADH) in liver cirrhosis with resistant ascites]. 268 81

Resistance to the pressor effects of angiotensin II, but not norepinephrine, has been observed in sodium depletion, potassium depletion, and cirrhosis. We tested the response to arginine vasopressin (AVP) in each of these conditions. Male Sprague-Dawley rats were made sodium depleted with furosemide and a low-sodium diet for 3 days, potassium depleted by feeding a low-potassium diet for 14-21 days, or cirrhotic by inhalation of carbon tetrachloride for 8 wk. In conscious rats, the pressor response to graded doses of AVP was reduced in sodium depletion by 27-43% compared with control rats. Sodium-depleted rats were also found to have enhanced baroreceptor reflexes, since the decrease in heart rate for a given increase in mean arterial pressure was greater than in control rats. When the ganglionic blocker pentolinium tartrate was given to sodium-depleted rats the pressor response to AVP was restored to control levels. In potassium-depleted rats the pressor response to AVP was 21-52% lower than that in controls, whereas cirrhotic rats also had a blunted response to AVP (14-41% lower than control). However, there was no evidence in either of these two states of enhanced baroreceptor activity, and pretreatment with pentolinium tartrate did not restore the pressor response to normal. Therefore, although resistance to the pressor effect of AVP was found in all three conditions, the mechanism of this effect was different in sodium depletion compared with potassium depletion and cirrhosis. We conclude that resistance to the pressor action of AVP in sodium depletion was secondary to resetting of the baroreceptors.
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PMID:Pressor resistance to vasopressin in sodium depletion, potassium depletion, and cirrhosis. 287 60

The diuretic effect of the supine position was evaluated in six patients with cirrhosis and ascites and six with congestive cardiac failure. All patients received 1 mg bumethanide intravenously and were randomly assigned to either bed rest in the supine position or normal daily activity in the upright position for the next six hours. The diuretic response was similar in patients with heart failure and cirrhosis, and was significantly greater in the supine than in the upright position: mean 1,133 v 626 ml/6 h (p less than 0.01). The natriuresis was similarly greater during recumbency: mean sodium 96 v 45 mmol (mEq)/6 h (p less than 0.01), and the excreted potassium in six hours was similar in both postures. The glomerular filtration rate was 100 and 66 ml/min (p less than 0.01) and the heart rate 76 and 83 beats/min (p less than 0.05) in the supine and upright positions, respectively. Plasma concentrations of noradrenaline, renin, and aldosterone rose significantly during the upright position. The results suggest that the attenuated response to intravenous bumethanide in the upright position and during normal daily activity may be due to the activation of several, homoeostatic mechanisms which may reduce the excretion of water and salt.
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PMID:[Effect of posture on the diuretic treatment of decompensated cirrhosis and heart failure]. 291 77


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