The Clinical Analysis Of Cirrhotic Ascites With Hyponatremia

Background: hyponatremia is very common in decompensated cirrhosis. There are many factors lead to the cirrhosis patient accompanied with hyponatremia, such as: limit sodium intake blindly,long-term application of diuretics,a great quantity of discharging ascites,alimentary tract hemorrhage,vomit,diarrhea,the deactivation barrier of aldosterone,AVP,estrogen In vivo and the concentration of atrial natriuretic peptide is much higher than aldosterone in advanced Patients. this disease onset slowly. The symptom is not obvious in some patients. some patients may have symptoms of hyponatremic encephalopathy such as mental disorders, lethargy, delirium, convulsions, coma, shock, etc. the hyponatremic encephalopathy may lead to central nervous system damage. The hyponatremic encephalopathy and hepatic encephalopathy are difficult to identify in clinical. Whether to have the hyponatremia is influence the prognosis and decreased survival in patients with cirrhosis. Therefore, the treatment of hyponatremia in patients with cirrhosis should also be more and more importance in clinical.Objective: To investigate the relationship of hyponatremia and cirrhosis, in order to improve the survival rate of patients with cirrhosis, and provide reference for the reasonable treatment.Methods: In this retrospective analysis covered 285 patients with decompensated cirrhosis in which 127 patients were combined with the hyponatremia in First Clinical Hospital of Jilin University from October 2008 to October 2009. Hyponatremia is divided into several groups according to serum sodium concentration: hyponatremia group (concentration<135 mmol/l),mild hyponatremia group (concentration 130mmol/l~135 mmol/l) moderate hyponatremia group (concentration 120 mmol/l~130 mmol/l),severe hyponatremia group (concentration≤120 mmol/l). To investigate the relationship between hyponatremia and the Child-Pugh classification of liver function,and complications (Hepatic encephalopathy, hepatorenal syndrome, upper gastrointestinal bleeding, spontaneous bacterial peritonitis, refractory ascites) in Decompensated cirrhosis patients. To research the associativity of hyponatremia with prothrombin time and the activity of prothrombin. To investigate the relationship between hyponatremia and other electrolytes (potassium, calcium, chlorine). To analyze the clinical outcome of cirrhosis patients.Results: (1) In this study including 285 decompensated cirrhosis patiens, in which 127 were combined with hyponatremia and the other 158 patients have a serum sodium in normal level. Hyponatremia in this study is 44.56%. The gender and age of the patients in the two groups showed no significant difference. (2) There are significant difference in the Child-Pugh classification of liver function between the two groups (P<0.05). There are also significant difference in the incidence rate of complications in cirrhosis patiens (hepatic encephalopathy, hepatorenal syndrome, spontaneous bacterial peritonitis, refractory ascites) between the two groups (P<0.05). (3) There are significant difference in the incidence rate of hypochloraemia in hyponatremia groups (mild, moderate and severe) (P <0.05). (4) There are significant difference in the clinical outcome between the severe hyponatremia group and the other two groups separately,the clinical outcome of severe hyponatremia groups is worse (P<0.05).Conclusion: (1) There are positive correlation between hyponatremia and the Child - Pugh classification of liver function. Lower serum sodium levels accompanyed with worse liver function. (2) Hyponatremia have positive correlation with the incidence rate of some complications in cirrhosis patiens such as: hepatic encephalopathy, spontaneous bacterial peritonitis, refractory ascites and so on. The in time supplement of sodium chloride according to serum sodium concentration could shorten the subside time of refractory ascites,reduce the incidence of hepatic encephalopathy and spontaneous peritonitis, also could improve the prognosis of the cirrhosis patient with hyponatremia. (3) The serum sodium concentration have positive correlation with the cure rate, Lower serum sodium levels, lower cure rate.