A Clinical Analysis Of 59 Cases Of The Cirrhosis Ascites With Hyponatremia

The hyponatremia is one of the most frequent electrolytedisturbances accompanied by the ascites of liver cirrhosis. It is easy tobe ignored due to the lack of clinical specificity and induced to becovered by the primary clinical symptoms of liver cirrhosis. Thus itprogressively resulted in the functional impairment of the mostimportant organs, such as brain, liver, lung and kidney. and led to themalignant recycle, further deteriorated the whole state of an illness. Soit seems predominantly important. to have an early diagnosis and areasonable therapy Objective: To analyze the hyponatremia cases with cirrhosis andascites. The clinical characteristics, therapeutics, the relationshipbetween the level of l hyponatremia and clinical turnover are supposedto be analyzed as the references of the diagnosis, therapeutics andprognosis of the hyponatremia. Methods: The retrospective analysis covered 117 ascites caseshospitalized in our hospital from Jan2004 to Jan 2005, of which 59cases were combined with the hyponatremia. The observation items areas follows: sex, age, case fatality, etiopathogenisis construction,common motivation, clinical manifestation, and the relationshipbetween levels of low sodium and hepatic encephalopathy, and clinicalturnover. Results: Of 117 cases of ascites, 59 cases combined with thehyponatremia which occupied 50.4%. Among them, male was 41(69.46%) while female was 18 (30.51%). The age varied from 22 to 85,the average was 54.50±12.22. The incidence peak appeared at50~59(44.06%). The frequent motivations were as follows: sodiumrestricted diet (22cases), excessive diuresis (32cases), nausea and vomit(16cases), uncorrected discharging ascites (12cases), diarrhea (9cases).Tow kinds of motivations were found simultaneously existed in 17cases, and more than two in 15cases. Excessive diureses was the mostfrequent inducement (69.4%) which led to hyponatremia. The causecomposition was as follows: posthepatic cirrhosis of B hepatitis.(21cases, 35.60%), alcoholic cirrhosis (14 cases,23.73%), posthepaticcirrhosis of C hepatitis(8cases, 13.56%), posthepatic alcoholic cirrhosis(6 cases, 10.17%), primary biliary cirrhosis (2 cases, 3.39%). Patientswith nausea and vomit were 15, with the loss of appetite were 17, withheadache were 13, with drowsiness were 22 with coma were6. Theincidences of the slight, medium and severe hyponatremia complicatedwith hepatic encephalopathy was 4%, 23.8%, 76.9% respectively,complicated with hepatorenal syndrome was 4%, 19.0%, 69.2%respectively. There is significant difference in fatality between slightand severe hyponatremia , and between medium and severehyponatremia. With the sodium lower ,the fatality obviouslyincreased.In the restrict-sodium team, there is significant difference inthe level of sodium , the depth of seroperitoneum and the urinaryproduction In the supply-sodium team comparing before and after.There is no significant difference in the level of the sodium ,the depthof seroperitoneum and the urinary production comparing beforesupplying and after supplying. With the sodium raised, the urinaryincreased, while the seroperitoneum decreasedConclusions: 1, the incidence of ascites combined with thehyponatremia is comparatively high, accounted to 50.43%.2,Excessivediureses is the most frequent inducement,so we should pay attention torational using the diuretic agent 2, its clinical manifestations are lack ofthe specificity and inclined to be covered by the primary clinicalsymptoms. the cerebropathy of hyposmolality is usual complicationwhich is induced to mix up with the hepatic encephalopathy. Moreattention should be given to the differential diagnosis and reasonabletreatment. 3, the level of low sodium has the positive correlation withthe incidence of hepatic encephalopathy, hepatorenal syndrome andmortality.4.the appropriate supplement of Hypertonic Saline has thedefinite effect on correcting the medium and severe hyponatremia.