HEPATIC CIRRHOSIS: EFFECTS OF SODIUM CHLORIDE ADMINISTRATION AND RESTRICTION AND OF ABDOMINAL PARACENTESIS ON ELECTROLYTE AND WATER BALANCE 12

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Abstract
The effects of NaCl admn. and restriction and of abdominal paracentesis on electrolyte and water balance were studied in 7 patients with cirrhosis of the liver and ascites. During periods of NaCl ingestion, ascites and edema accumulated at a rate approximating that expected if salt was retained isotonically. When Na was subsequently restricted the accumulation of fluid ceased and daily urine vols. increased by amts. approximating the daily wt. gains during periods of Na ingestion. With continued dietary Na restriction, improvement in clinical nutritional status, a progressive rise in the serum albumin and Na concns. and fall in hematocrit usually occurred. Gradual diuresis with loss of ascites and edema accompanied these changes. Immediately following abdominal paracentesis Na was not retained isotonically in some patients. Water was retained in excess of salt. This phenomenon is explained as follows: after paracentesis hemoconcn. occurred. The patient responded to this by anti-diuresis. Since Na was being maximally retained, the resulting water retention contributed to hyponatremia which was most marked following paracentesis. The effective systemic plasma volume apparently is decreased in patients with cirrhosis of the liver and ascites who have had repeated paracenteses; and that the increased antidiuretic activity and the decreased Na content of the urine of these patients in part may result from homeostatic responses initiated by abdominal paracentesis, and also by the initial formation of ascites.