HYPONATREMIA IN HEPATIC CIRRHOSIS FOLLOWING PARACENTESIS 1

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Abstract
Two patients with portal cirrhosis and ascites (but without peripheral edema) were studied with regard to changes occurring in relation to paracentesis, which included apathy, weakness, confusion, nausea, vomiting, muscle cramps, hypotension, narrow pulse pressure, tachycardia, hemo-concentration, hyponatremia, hypochloremia and elevation of the serum non-protein nitrogen. Following intraven. admn. of hypertonic saline soln. these manifestations disappeared. Furthermore they did not occur when isotonic saline was given following other paracenteses. The authors believe that the rapid reaccumulation of ascites following paracentesis led to a diminished plasma volume and that the accompanying thirst with its resultant considerable pure water ingestion produced the hyponatremia. Although the total volume of extracellular fluid (interstitial plus plasma plus ascitic fluid) was large, the effective volume (interstitial plus plasma) was actually reduced; this they believe to be an important feature of the syndrome. They also noted that when one of the patients had peripheral edema, paracentesis was not accompanied by the development of the syndrome, but that ascites reaccumulated at the expense of the edema fluid without net weight change.