Treatment of Cirrhosis-Associated Hyponatremia Refractory to Vasopressin 2-Receptor Antagonist

Abstract

Hyponatremia in patients with cirrhosis is due to impaired water excretion from persistent release of antidiuretic hormone induced by diminished effective circulatory volume (ECV). The treatment of cirrhosis-associated hyponatremia is free water restriction and vasopressin-2-receptor antagonists (V2RAs). We report a cirrhotic patient with hyponatremia who failed to improve with V2RAs but corrected with treatment of hepatorenal syndrome (HRS). The failure of hyponatremia to improve with V2RAs was likely due to avid renal proximal Na⁺ and H₂O reabsorption from decreased ECV, resulting in diminished fluid delivery to the collecting tubule. Midodrine and octreotide improved the systemic hemodynamics and increased distal fluid delivery resulting in resolution of hyponatremia. To date, this is the first case report of a cirrhotic patient with hyponatremia refractory to V2RAs that resolved with treatment of HRS.




J Med Cases. 2014;5(5):264-266
doi: http://dx.doi.org/10.14740/jmc1745w