Prognostic value of spontaneous hyponatremia in cirrhosis with ascites

Spontaneous hyponatremia in cirrhosis with ascites is generally considered to be due to an impaired renal ability to excrete free water, to be a contraindication of diuretics, and to be a bad prognostic sign. These concepts are reviewed in this paper. 55 cirrhotics with ascites were divided into three groups. Group I consisted of 13 patients with hyponatremia and very low free-water clearance (\(C_{H_2 O} \), 0.07±0.26 ml/min). These patients also had poor renal function: low inulin clearance (C _INU , 40.6±25.9 ml/min) and paraamino-hippurate clearance (C _PAH , 383±275 ml/min). Group II consisted of 8 patients who also had hyponatremia.\(C_{H_2 O} \), C _INU , and C _PAH in these patients were fairly high: 5.85±1.53 ml/min, 85.7±26.2 ml/min, and 651±294 ml/min. These values are similar to those of the 34 patients without hyponatremia who make up Group III: (6.37±4.27 ml/min, 94.7±33.1 ml/min, and 598±199 ml/min). Hyponatremia in Group I could be related to the impaired free-water clearance. The mechanism of hyponatremia in Group II patients is not clear. Patients with hyponatremia and low C _INU and C _PAH had a negative response to diuretics and a poor prognosis. Patients with hyponatremia but with relatively good renal function had a good prognosis, similar to Group III patients. They responded to diuretics with no worsening of their hyponatremia.