Mechanisms of improvement of water and sodium excretion by immersion in decompensated cirrhotic patients

Kidney Int. 1983 Dec;24(6):788-94. doi: 10.1038/ki.1983.229.

Abstract

Eight patients with alcoholic liver disease, ascites, and edema were found to have impaired water (36 +/- 6% in 5 hr) and sodium (3.9 +/- 1.1 mEq/5 hr) excretion during a 20 ml/kg water load. These patients were submitted to a 5-hr head-out water immersion (HWI) with hemodynamic monitoring (Swan-Ganz). HWI increased cardiac index (3.3 to 4.2 liters/min/m2), right atrial pressure (RAP, 3.9 to 9.0 mm Hg), and wedge capillary pulmonary pressure (9.8 to 15.4 mm Hg) (all P less than 0.01). HWI decreased plasma renin activity (6.4 to 4.5 ng/ml/hr, P less than 0.001), aldosterone (73 to 43 ng/dl, P less than 0.001), arginine vasopressin (AVP, 1.03 +/- 0.15 to 0.76 +/- 0.08 pg/ml, P less than 0.005), norepinephrine (NE, 584 to 435 pg/ml, P less than 0.001) and increased the percentage of water load excreted (36 to 63%, P less than 0.005) and urinary sodium excretion (3.9 to 9.7 mEq/5 hr, P less than 0.05). The percentage of water load excreted was inversely correlated to AVP levels (r = 0.52, P less than 0.05) and directly correlated to RAP (r = 0.74, P less than 0.05). A significant positive correlation was also found between the increase in fractional excretion of sodium (delta FENa) and the increase in RAP (r = 0.77, P less than 0.001). FENa also correlated inversely with NE levels (r = 0.56, P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Arginine Vasopressin / blood
  • Blood Pressure
  • Blood Volume
  • Cardiac Output
  • Diuresis*
  • Female
  • Humans
  • Immersion*
  • Kidney / physiopathology
  • Liver Cirrhosis, Alcoholic / blood
  • Liver Cirrhosis, Alcoholic / physiopathology*
  • Male
  • Middle Aged
  • Natriuresis*
  • Norepinephrine / blood
  • Pressoreceptors / physiopathology
  • Pulmonary Wedge Pressure
  • Renin-Angiotensin System
  • Stroke Volume
  • Vascular Resistance

Substances

  • Arginine Vasopressin
  • Norepinephrine