Total paracentesis in cirrhotic patients with tense ascites and dilutionalhyponatremia

OBJECTIVE: The safety of large-volume paracentesis with plasma expander inf usion in ascitic cirrhotic patients with advanced liver disease, hyponatrem ia, or renal failure has not been elucidated. Our aim was to investigate th e safety of total paracentesis in cirrhotic patients with ascites and sever e hyponatremia. METHODS: Forty-five cirrhotic patients with tense ascites were treated with total paracentesis and infusion of plasma expanders. At inclusion, 20 pati ents showed severe hyponatremia (serum sodium <130 mEq/L). In the remaining 25 patients, serum sodium was >130 mEq/L (range, 133-146 mEq/L). RESULTS: Plasma renin activity (PRA) and plasma aldosterone concentration ( PAC) were significantly higher in patients with hyponatremia(PRA: 19.7 +/- 5.8 ng/mL/h; PAC: 217 +/- 35 ng/dL) than in those patients without hyponatr emia (PRA: 4.9 +/- 1.1 ng/ml/h; PAC: 95 +/- 31 ng/dL), indicating a more se vere systemic hemodynamic deterioration. After paracentesis, PRA and PAC in creased similarly in both groups of patients. Serum sodium levels remained unchanged after paracentesis in patients with hyponatremia (127 +/- 0.5 to 128 +/- 1.5 mEq/L) and decreased slightly in patients without hyponatremia (137 +/- 1 to 135 +/- 1 mEq/L; p < 0.005). The incidence of complications d uring the first hospitalization, the probability of readmission for complic ations of cirrhosis, and the probability of survival at 1 yr were similar i n both groups of patients. CONCLUSIONS: These results indicate that therapeutic paracentesis is a safe treatment for tense ascites in cirrhotic patients with severe hyponatremia . (Am J Gastroenterol 1999;94:2219-2223. (C) 1999 by Am. Cell. of Gastroent erology).