The Significance of Urine Sodium Measurement after Furosemide Administration in Diuretics-unresponsive Patients with Liver Cirrhosis |
Hyun Seok Cho, M.D., Geun Tae Park, M.D., Young Hoon Kim, M.D., Sung Gon Shim, M.D.,
Jin Bae Kim, M.D., Oh Young Lee, M.D., Ho Soon Choi, M.D., Joon Soo Hahm, M.D.
and Min Ho Lee, M.D. |
Research Institute of Digestive Disease, Hanyang University College of Medicine, Seoul, Korea |
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ABSTRACT |
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Background/Aims The diagnosis of refractory ascites means a poor prognosis for patients with liver
cirrhosis. The definition of refractory ascites has already been established, but using the dosage of diuretics
that correlates with the definition of refractory ascites in an out-patient department will lower the compliance
of the patient, as well as causing serious complications, such as hepatic encephalopathy and hyponatremia, as
the dosage of diuretics is increased. Due to this fact, it is very difficult to apply this definition of refractory
ascites to patients in a domestic out-patient department. In this study, in situations where there are difficulties
in applying the diuretics dosage according to definition of refractory ascites, we tried to find out whether
measuring the value of urine sodium after the administration of intravenous furosemide can be the standard in
early differentiation of the response to diuretics treatment. Methods: We reviewed 16 cases of liver cirrhosis
with ascites and classified them into two groups by the response to diuretics. The diuretics-responsive ascites
group was 8 cases and the diuretics-unresponsive ascites group consisted of 8 cases. After admission, we
examined the patients’ CBC, biochemical liver function test, spot urine sodium, and 24 hour creatinine clearance.
After the beginning of the experiment, all diuretic therapy was stopped for 3 days. Daily we examined the
patients’ CBC, biochemical liver function test, and in the 3rd experiment day, we measured 24-hour urine
volume and sodium. In the 4th experiment day, after sampling for ADH, plasma renin activity and plasma
aldosterone level, we administrated the furosemide 80 mg I.V, and measured the amount of 8 hour urine volume
and sodium. Results: The plasma aldosterone level was significantly higher in the diuretics- unresponsive
ascites group than in the diuretics-responsive ascites group. In the 4th experiment day, the amount of urine
volume and sodium was very significantly lower in the diuretics-unresponsive ascites group than in the
diuretics-responsive ascites group (1297.5±80.9 vs 2003.7±114.6 ml, p<0.005, 77.3±8.2 vs 211.8±12.6 mEq,
p<0.001). Conclusions: In out-patient departments, the measurement of urine sodium 8 hours after
administrating 80 mg of intravenous furosemide, will help in differentiating ascites patients with lower
treatment response to diuretics.(Korean J Hepatol 2003;9:324-331) |
KeyWords:
Ascites, Furosemide, Liver cirrhosis |
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