PATTERN OF SODIUM HANDLING AND ITS CONSEQUENCES IN PATIENTS WITH PREASCITIC CIRRHOSIS

Background/Aims: The initial abnormalities in the renal sodium handlin g in patients with cirrhosis before developing ascites remain unknown. The aim of this study is to further characterize sodium metabolism an d the effects of sodium loading in preascitic cirrhosis. Methods: Eigh t male, preascitic patients with cirrhosis and 6 volunteers had their daily urinary sodium excretion level measured while on a strictly meta bolically controlled diet, first consisting of 20 mmol then of 200 mmo l sodium per day each for 7 days. Central blood volume, plasma norepin ephrine, and atrial natriuretic factor levels were measured during eac h diet. Results: Preascitic patients with cirrhosis had significantly less daily urinary sodium excretion on both diets. Volume expansion in the patients with cirrhosis was indicated by significantly greater we ight gain and higher atrial natriuretic factor levels for each diet. P atients with cirrhosis had central blood Volume expansion (1725 +/- 54 mL/m(2)) compared with controls (1495 +/- 81 mL/m(2); P = 0.03) on a low-sodium diet. This increased significantly in the controls (1864 +/ - 164 mL/m(2); P = 0.04) on a high-sodium diet, associated with suppre ssion of plasma norepinephrine, but not in the patients with cirrhosis (1679 +/- 107 mL/m(2); P > 0.05). Conclusions: Failure of further cen tral blood volume expansion in the patients with cirrhosis on high-sod ium diet in the presence of significant weight gain suggests maldistri bution away from the effective arterial blood volume. This study provi des further reasons why preascitic patients with cirrhosis might benef it from sodium restriction.