본문 바로가기
KERD
논문KCI 등재

Evidence-based hyponatremia management in liver disease

백선하|Ji Young Ryu|Sejoong Kim
대한간학회 (The korean Association for the Study of the Liver)|2023.10|Clinical and Molecular Hepatology|제29권 제4호|pp. 924-944

2

조회

0

다운로드

3

인용

0

참고문헌

키워드

HyponatremiaLiver diseaseLiver cirrhosisWater-electrolyte imbalance

초록

Hyponatremia is primarily a water balance disorder associated with high morbidity and mortality. The pathophysiological mechanisms behind hyponatremia are multifactorial, and diagnosing and treating this disorder remains challenging. In this review, the classification, pathogenesis, and step-by-step management approaches for hyponatremia in patients with liver disease are described based on recent evidence. We summarize the five sequential steps of the traditional diagnostic approach: 1) confirm true hypotonic hyponatremia, 2) assess the severity of hyponatremia symptoms, 3) measure urine osmolality, 4) classify hyponatremia based on the urine sodium concentration and extracellular fluid status, and 5) rule out any coexisting endocrine disorder and renal failure. Distinct treatment strategies for hyponatremia in liver disease should be applied according to the symptoms, duration, and etiology of disease. Symptomatic hyponatremia requires immediate correction with 3% saline. Asymptomatic chronic hyponatremia in liver disease is prevalent and treatment plans should be individualized based on diagnosis. Treatment options for correcting hyponatremia in advanced liver disease may include water restriction; hypokalemia correction; and administration of vasopressin antagonists, albumin, and 3% saline. Safety concerns for patients with liver disease include a higher risk of osmotic demyelination syndrome.

Abstract

Hyponatremia is primarily a water balance disorder associated with high morbidity and mortality. The pathophysiological mechanisms behind hyponatremia are multifactorial, and diagnosing and treating this disorder remains challenging. In this review, the classification, pathogenesis, and step-by-step management approaches for hyponatremia in patients with liver disease are described based on recent evidence. We summarize the five sequential steps of the traditional diagnostic approach: 1) confirm true hypotonic hyponatremia, 2) assess the severity of hyponatremia symptoms, 3) measure urine osmolality, 4) classify hyponatremia based on the urine sodium concentration and extracellular fluid status, and 5) rule out any coexisting endocrine disorder and renal failure. Distinct treatment strategies for hyponatremia in liver disease should be applied according to the symptoms, duration, and etiology of disease. Symptomatic hyponatremia requires immediate correction with 3% saline. Asymptomatic chronic hyponatremia in liver disease is prevalent and treatment plans should be individualized based on diagnosis. Treatment options for correcting hyponatremia in advanced liver disease may include water restriction; hypokalemia correction; and administration of vasopressin antagonists, albumin, and 3% saline. Safety concerns for patients with liver disease include a higher risk of osmotic demyelination syndrome.

참고문헌 (129)

  1. Spasovski G, "Clinical practice guideline on diagnosis and treatment of hyponatraemia", Eur J Endocrinol, 170, pp.G1~G47 (2014)
  2. Ginés P, "Hyponatremia in cirrhosis : from pathogenesis to treatment", Hepatology, 28, pp.851~864 (1998)
  3. Angeli P, "Hyponatremia in cirrhosis : results of a patient population survey", Hepatology, 44, pp.1535~1542 (2006)
  4. Guevara M, "Hyponatremia is a risk factor of hepatic encephalopathy in patients with cirrhosis : a prospective study with timedependent analysis", Am J Gastroenterol, 104, pp.1382~1389 (2009)
  5. Heuman DM, "Persistent ascites and low serum sodium identify patients with cirrhosis and low MELD scores who are at high risk for early death", Hepatology, 40, pp.802~810 (2004)
  6. Borroni G, "Clinical relevance of hyponatraemia for the hospital outcome of cirrhotic patients", Dig Liver Dis, 32, pp.605~610 (2000)
  7. Crivellin C, "Risk factors for central pontine and extrapontine myelinolysis after liver transplantation : a single-center study", Transplantation, 99, pp.1257~1264 (2015)
  8. Forns X, "Management of ascites and renal failure in cirrhosis", Semin Liver Dis, 14, pp.82~96 (1994)
  9. Abelmann WH, "Hyperdynamic circulation in cirrhosis : a historical perspective", Hepatology, 20, pp.1356~1358 (1994)
  10. Groszmann RJ, "Hyperdynamic circulation of liver disease 40years later : pathophysiology and clinical consequences", Hepatology, 20, pp.1359~1363 (1994)
  11. Ginès P, "Pathogenesis of ascites in cirrhosis", Semin Liver Dis, 17, pp.175~189 (1997)
  12. Iwakiri Y, "Pathophysiology of portal hypertension", Clin Liver Dis, 18, pp.281~291 (2014)
  13. Martell M, "Physiopathology of splanchnic vasodilation in portal hypertension", World J Hepatol, 2, pp.208~220 (2010)
  14. John S, "Hyponatremia in cirrhosis : pathophysiology and management", World J Gastroenterol, 21, pp.3197~3205 (2015)
  15. Ginès P, "Hyponatremia in cirrhosis : pathogenesis, clinical significance, and management", Hepatology, 48, pp.1002~1010 (2008)
  16. Asbert M, "Circulating levels of endothelin in cirrhosis", Gastroenterology, 104, pp.1485~1491 (1993)
  17. Henriksen JH, "Estimated central blood volume in cirrhosis : relationship to sympathetic nervous activity, betaadrenergic blockade and atrial natriuretic factor", Hepatology, 16, pp.1163~1170 (1992)
  18. Arroyo V, "Plasma renin activity and urinary sodium excretion as prognostic indicators in nonazotemic cirrhosis with ascites", Ann Intern Med, 94, pp.198~201 (1981)
  19. Liamis G, "Spurious electrolyte disorders : a diagnostic challenge for clinicians", Am J Nephrol, 38, pp.50~57 (2013)
  20. Schrier RW, "Diseases of the Kidney & Urinary Tract. Vol. 3" (2006), Lippincott Williams & Wilkins
  21. Knepper MA, "Renal aquaporins", Kidney Int, 49, pp.1712~1717 (1996)
  22. Nielsen S, "The aquaporin family of water channels in kidney : an update on physiology and pathophysiology of aquaporin-2", Kidney Int, 49, pp.1718~1723 (1996)
  23. King LS, "Pathophysiology of the aquaporin water channels", Annu Rev Physiol, 58, pp.619~648 (1996)
  24. Knepper MA, "Molecular physiology of urinary concentrating mechanism : regulation of aquaporin water channels by vasopressin", Am J Physiol, 272(1 Pt 2), pp.F3~F12 (1997)
  25. Fushimi K, "Cloning and expression of apical membrane water channel of rat kidney collecting tubule", Nature, 361, pp.549~552 (1993)
  26. Agre P, "The aquaporin family of water channels in kidney", Nephrologie, 17, pp.409~415 (1996)
  27. Liamis G, "Hyponatremia in patients with liver diseases : not just a cirrhosis-induced hemodynamic compromise", Hepatol Int, 10, pp.762~772 (2016)
  28. Bozanich NK, "Renal insufficiency in the patient with chronic liver disease", Clin Liver Dis, 19, pp.45~56 (2015)
  29. Qureshi MO, "Renal failure in patients with end stage liver disease and its impact on clinical outcome", J Coll Physicians Surg Pak, 24, pp.628~631 (2014)
  30. Liamis G, "Hyponatremia in patients with infectious diseases", J Infect, 63, pp.327~335 (2011)
  31. Gupta A, "Glomerular diseases associated with hepatitis B and C", Adv Chronic Kidney Dis, 22, pp.343~351 (2015)
  32. Filippatos TD, "Hyponatremia in patients with heart failure", World J Cardiol, 5, pp.317~328 (2013)
  33. Handler J, "Well tolerated spironolactone-related hyponatremia", J Clin Hypertens(Greenwich), 10, pp.317~321 (2008)
  34. Yim SY, "Risk factors for developing hyponatremia during terlipressin treatment : a retrospective analyses in variceal bleeding", J Clin Gastroenterol, 49, pp.607~612 (2015)
  35. Han X, "A retrospective analysis of hyponatremia during terlipressin treatment in patients with esophageal or gastric variceal bleeding due to portal hypertension", JGH Open, 4, pp.368~370 (2019)
  36. Xu X, "Development of hyponatremia after terlipressin in cirrhotic patients with acute gastrointestinal bleeding : a retrospective multicenter observational study", Expert Opin Drug Saf, 19, pp.641~647 (2020)
  37. Johnson PJ, "Brivanib versus sorafenib as first-line therapy in patients with unresectable, advanced hepatocellular carcinoma : results from the randomized phase III BRISK-FL study", J Clin Oncol, 31, pp.3517~3524 (2013)
  38. Abou-Alfa GK, "A phase II study of cixutumumab(IMC-A12, NSC742460)in advanced hepatocellular carcinoma", J Hepatol, 60, pp.319~324 (2014)
  39. Hedrick KT, "Probable boceprevir-induced hyponatremia in a patient with chronic hepatitis C", Am J Health Syst Pharm, 72, pp.449~452 (2015)
  40. Arieff AI, "Neurological manifestations and morbidity of hyponatremia: correlation with brain water and electrolytes", Medicine(Baltimore), 55, pp.121~129 (1976)
  41. Schrier RW, "Body water homeostasis : clinical disorders of urinary dilution and concentration", J Am Soc Nephrol, 17, pp.1820~1832 (2006)
  42. Adrogué HJ, "Hyponatremia", N Engl J Med, 342, pp.1581~1589 (2000)
  43. Adrogué HJ, "The challenge of hyponatremia", J Am Soc Nephrol, 23, pp.1140~1148 (2012)
  44. Ginès A, "Incidence, predictive factors, and prognosis of the hepatorenal syndrome in cirrhosis with ascites", Gastroenterology, 105, pp.229~236 (1993)
  45. Rose BD, "Clinical Physiology of Acid-Base and Electrolyte Disorders" (2001), McGraw-Hill
  46. Yeates KE, "Salt and water : a simple approach to hyponatremia", CMAJ, 170, pp.365~369 (2004)
  47. Verbalis JG, "Hyponatremia treatment guidelines 2007 : expert panel recommendations", Am J Med, 120(11 Suppl 1), pp.S1~S21 (2007)
  48. Hillier TA, "Hyponatremia : evaluating the correction factor for hyperglycemia", Am J Med, 106, pp.399~403 (1999)
  49. Katz MA, "Hyperglycemia-induced hyponatremia--calculation of expected serum sodium depression", N Engl J Med, 289, pp.843~844 (1973)
  50. Filippatos TD, "Recommendations for severe hypertriglyceridemia treatment, are there new strategies?", Curr Vasc Pharmacol, 12, pp.598~616 (2014)
  51. Hussain I, "Extreme hypercholesterolemia presenting with pseudohyponatremia-a case report and review of the literature", J Clin Lipidol, 9, pp.260~264 (2015)
  52. Garibaldi BT, "Pseudohyponatremia in a patient with HIV and hepatitis C coinfection", J Gen Intern Med, 23, pp.202~205 (2008)
  53. Farooqi MS, "A woman with primary biliary cirrhosis and hyponatremia", Clin Chem, 61, pp.1028~1031 (2015)
  54. Filippatos TD, "Ten common pitfalls in the evaluation of patients with hyponatremia", Eur J Intern Med, 29, pp.22~25 (2016)
  55. 이연희, "Korean Society of Nephrology 2022 Recommendations on controversial issues in diagnosis and management of hyponatremia", Kidney Research and Clinical Practice, 41(4), pp.393~411 (2022), 대한신장학회[DOI]
  56. Rondon-Berrios H, "Vasopressin receptor antagonists in hyponatremia: uses and misuses", Front Med(Lausanne), 4, pp.141~ (2017)
  57. Jiménez JV, "Electrolyte and acid-base disturbances in end-stage liver disease : a physiopathological approach", Dig Dis Sci, 62, pp.1855~1871 (2017)
  58. Murthy KA, "A study of viral hepatitis e infection in a tertiary care hospital in mysore, South India", Open Forum Infect Dis, 1, pp.ofu036~ (2014)
  59. Cárdenas A, "Hyponatremia influences the outcome of patients with acute-on-chronic liver failure: an analysis of the CANONIC study", Crit Care, 18, pp.700~ (2014)
  60. Sterns RH, "Brain volume regulation in response to hypo-osmolality and its correction", Am J Med, 119(7Suppl 1), pp.S12~S16 (2006)
  61. Videen JS, "Human cerebral osmolytes during chronic hyponatremia. A proton magnetic resonance spectroscopy study", J Clin Invest, 95, pp.788~793 (1995)
  62. Häussinger D, "Low grade cerebral edema and the pathogenesis of hepatic encephalopathy in cirrhosis", Hepatology, 43, pp.1187~1190 (2006)
  63. The Korean Association for the Study of the Liver, "KASL clinical practice guidelines for liver cirrhosis: Varices, hepatic encephalopathy, and related complications", Clinical and Molecular Hepatology, 26(2), pp.83~127 (2020), 대한간학회[DOI]
  64. Arroyo V, "Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. International Ascites Club", Hepatology, 23, pp.164~176 (1996)
  65. Salerno F, "Refractory ascites : pathogenesis, definition and therapy of a severe complication in patients with cirrhosis", Liver Int, 30, pp.937~947 (2010)
  66. Moore CM, "Cirrhotic ascites review : pathophysiology, diagnosis and management", World J Hepatol, 5, pp.251~263 (2013)
  67. Fortune B, "Ascites, refractory ascites and hyponatremia in cirrhosis", Gastroenterol Rep(Oxf), 5, pp.104~112 (2017)
  68. Stanley MM, "Peritoneovenous shunting as compared with medical treatment in patients with alcoholic cirrhosis and massive ascites. Veterans Administration Cooperative Study on Treatment of Alcoholic Cirrhosis with Ascites", N Engl J Med, 321, pp.1632~1638 (1989)
  69. Planas R, "Natural history of patients hospitalized for management of cirrhotic ascites", Clin Gastroenterol Hepatol, 4, pp.1385~1394 (2006)
  70. Russ KB, "Acute kidney injury in patients with cirrhosis", J Clin Transl Hepatol, 3, pp.195~204 (2015)
  71. Pereira G, "Combination and sequential evaluation of acute-onchronic liver failure(ACLF)and hyponatremia and prognosis in cirrhotic patients", Dig Liver Dis, 52, pp.91~97 (2020)
  72. Lopes-Secundo TM, "Serum sodium, model for endstage liver disease, and a recent invasive procedure are risk factors for severe acute-on-chronic liver failure and death in cirrhotic patients hospitalized with bacterial infection", Eur J Gastroenterol Hepatol, 30, pp.1055~1059 (2018)
  73. Biggins SW, "Evidence-based incorporation of serum sodium concentration into MELD", Gastroenterology, 130, pp.1652~1660 (2006)
  74. "Liver policy"[URL]
  75. Leise MD, "Effect of the pretransplant serum sodium concentration on outcomes following liver transplantation", Liver Transpl, 20, pp.687~697 (2014)
  76. Yun BC, "Impact of pretransplant hyponatremia on outcome following liver transplantation", Hepatology, 49, pp.1610~1615 (2009)
  77. Dawwas MF, "The impact of serum sodium concentration on mortality after liver transplantation : a cohort multicenter study", Liver Transpl, 13, pp.1115~1124 (2007)
  78. Londoño MC, "Hyponatremia impairs early posttransplantation outcome in patients with cirrhosis undergoing liver transplantation", Gastroenterology, 130, pp.1135~1143 (2006)
  79. King JD, "Osmotic demyelination syndrome", Am J Med Sci, 339, pp.561~567 (2010)
  80. Go Suryeong, "Association between copeptin levels and treatment responses to hypertonic saline infusion in patients with symptomatic hyponatremia: a prospective cohort study", Kidney Research and Clinical Practice, 40(3), pp.371~382 (2021), 대한신장학회[DOI]
  81. Verbalis JG, "Diagnosis, evaluation, and treatment of hyponatremia : expert panel recommendations", Am J Med, 126(10 Suppl 1), pp.S1~S42 (2013)
  82. Baek SH, "Risk of overcorrection in rapid intermittent bolus vs slow continuous infusion therapies of hypertonic saline for patients with symptomatic hyponatremia : The SALSA randomized clinical trial", JAMA Intern Med, 181, pp.81~92 (2021)
  83. Crismale JF, "Prevention of the osmotic demyelination syndrome after liver transplantation : a multidisciplinary perspective", Am J Transplant, 17, pp.2537~2545 (2017)
  84. Sigal SH, "Management strategies and outcomes for hyponatremia in cirrhosis in the hyponatremia registry", Can J Gastroenterol Hepatol, 2018, pp.1579508~ (2018)
  85. Veeraveedu PT, "Arginine vasopressin receptor antagonists(vaptans) : pharmacological tools and potential therapeutic agents", Drug Discov Today, 15, pp.826~841 (2010)
  86. Holmes CL, "Science review: vasopressin and the cardiovascular system part 1--receptor physiology", Crit Care, 7, pp.427~434 (2003)
  87. Quittnat F, "Vaptans and the treatment of water-retaining disorders", Semin Nephrol, 26, pp.234~243 (2006)
  88. Pose E, "Limited efficacy of tolvaptan in patients with cirrhosis and severe hyponatremia : real-life experience", Am J Med, 130, pp.372~375 (2017)
  89. Schrier RW, "Tolvaptan, a selective oral vasopressin V2-receptor antagonist, for hyponatremia", N Engl J Med, 355, pp.2099~2112 (2006)
  90. Cárdenas A, "Tolvaptan, an oral vasopressin antagonist, in the treatment of hyponatremia in cirrhosis", J Hepatol, 56, pp.571~578 (2012)
  91. Rai N, "Midodrine and tolvaptan in patients with cirrhosis and refractory or recurrent ascites : a randomised pilot study", Liver Int, 37, pp.406~414 (2017)
  92. Wang S, "Tolvaptan treatment improves survival of cirrhotic patients with ascites and hyponatremia", BMC Gastroenterol, 18, pp.137~ (2018)
  93. Tang J, "Tolvaptan therapy of Chinese cirrhotic patients with ascites after insufficient diuretic routine medication responses : a phase III clinical trial", BMC Gastroenterol, 20, pp.391~ (2020)
  94. Dahl E, "Meta-analysis : the safety and efficacy of vaptans(tolvaptan, satavaptan and lixivaptan)in cirrhosis with ascites or hyponatraemia", Aliment Pharmacol Ther, 36, pp.619~626 (2012)
  95. Yan L, "The treatment of vasopressin V2-receptor antagonists in cirrhosis patients with ascites : a meta-analysis of randomized controlled trials", BMC Gastroenterol, 15, pp.65~ (2015)
  96. Li M, "Impact of vaptans on clinical outcomes in cirrhosis patients : a meta-analysis of randomized controlled trials", Front Pharmacol, 10, pp.1365~ (2019)
  97. Hayashi M, "Association between the serum sodium levels and the response to tolvaptan in liver cirrhosis patients with ascites and hyponatremia", Intern Med, 57, pp.2451~2458 (2018)
  98. 허혁, "Evaluating the Safety and effectivenesS in adult KorEaN patients treated with Tolvaptan for management of autosomal domInAnt poLycystic kidney disease (ESSENTIAL): short-term outcomes during the titration period", Kidney Research and Clinical Practice, 42(2), pp.216~228 (2023), 대한신장학회[DOI]
  99. "FDA drug safety communication: FDA limits duration and usage of Samsca (tolvaptan) due to possible liver injury leading to organ transplant or death"[URL]
  100. Torres VE, "Tolvaptan in patients with autosomal dominant polycystic kidney disease", N Engl J Med, 367, pp.2407~2418 (2012)
  101. European Association for the Study of the Liver, "EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis", J Hepatol, 69, pp.406~460 (2018)
  102. The Korean Association for the Study of the Liver, "2017 KASL clinical practice guidelines management of hepatitis C: Treatment of chronic hepatitis C", Clinical and Molecular Hepatology, 24(3), pp.230~277 (2018), 대한간학회
  103. Fukui H, "Evidence-based clinical practice guidelines for liver cirrhosis 2015", J Gastroenterol, 51, pp.629~650 (2016)
  104. Salerno F, "Albumin infusion improves outcomes of patients with spontaneous bacterial peritonitis : a meta-analysis of randomized trials", Clin Gastroenterol Hepatol, 11, pp.123~130 (2013)
  105. Sort P, "Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis", N Engl J Med, 341, pp.403~409 (1999)
  106. Wong F, "Terlipressin plus albumin for the treatment of type 1 hepatorenal syndrome", N Engl J Med, 384, pp.818~828 (2021)
  107. Caraceni P, "Long-term albumin administration in decompensated cirrhosis (ANSWER): an openlabel randomised trial", Lancet, 391, pp.2417~2429 (2018)
  108. Bai Z, "Albumin infusion may decrease the incidence and severity of overt hepatic encephalopathy in liver cirrhosis", Aging(Albany NY), 11, pp.8502~8525 (2019)
  109. Florence Wong, "Management of refractory ascites", Clinical and Molecular Hepatology, 29(1), pp.16~32 (2023), 대한간학회
  110. McCormick PA, "Intravenous albumin infusion is an effective therapy for hyponatraemia in cirrhotic patients with ascites", Gut, 31, pp.204~207 (1990)
  111. Caraceni P, "AISF-SIMTI position paper on the appropriate use of albumin in patients with liver cirrhosis: a 2020 update", Blood Transfus, 19, pp.9~13 (2021)
  112. Shen NT, "Benefit of albumin infusion in hospitalized patients with cirrhosis and hyponatremia : a retrospective cohort study", J Gastroenterol Hepatol Res, 6, pp.2441~2445 (2017)
  113. Bajaj JS, "The impact of albumin use on resolution of hyponatremia in hospitalized patients with cirrhosis", Am J Gastroenterol, 113, pp.1339~ (2018)
  114. China L, "Targeted albumin therapy does not improve short-term outcome in hyponatremic patients hospitalized with complications of cirrhosis : data from the ATTIRE trial", Am J Gastroenterol, 116, pp.2292~2295 (2021)
  115. Zaccherini G, "Correction and prevention of hyponatremia in patients with cirrhosis and ascites: post hoc analysis of the ANSWER study database", Am J Gastroenterol, 118, pp.168~173 (2023)
  116. Bai Z, "Use of human albumin administration for the prevention and treatment of hyponatremia in patients with liver cirrhosis : a systematic review and meta-analysis", J Clin Med, 11, pp.5928~ (2022)
  117. Bai Z, "Effects of short-term human albumin infusion for the prevention and treatment of hyponatremia in patients with liver cirrhosis", J Clin Med, 12, pp.107~ (2022)
  118. Chinese Society of Hepatology, "Chinese guidelines on the management of ascites and its related complications in cirrhosis", Hepatol Int, 13, pp.1~21 (2019)
  119. Hackworth WA, "Effect of hyponatraemia on outcomes following orthotopic liver transplantation", Liver Int, 29, pp.1071~1077 (2009)
  120. Jong Man Kim, "Outcomes after Liver Transplantation in Korea: Incidence and Risk Factors from Korean Transplantation Registry", Clinical and Molecular Hepatology, 27(3), pp.451~462 (2021), 대한간학회[DOI]
  121. Cywinski JB, "Association between donor-recipient serum sodium differences and orthotopic liver transplant graft function", Liver Transpl, 14, pp.59~65 (2008)
  122. Romanovsky A, "Serum sodium shift in hyponatremic patients undergoing liver transplantation : a retrospective cohort study", Ren Fail, 37, pp.37~44 (2015)
  123. Leise M, "Hyponatremia in cirrhosis : implications for liver transplantation", Liver Transpl, 24, pp.1612~1621 (2018)
  124. Singh TD, "Central pontine and extrapontine myelinolysis : a systematic review", Eur J Neurol, 21, pp.1443~1450 (2014)
  125. Lee EM, "Risk factors for central pontine and extrapontine myelinolysis following orthotopic liver transplantation", Eur Neurol, 62, pp.362~368 (2009)
  126. Morard I, "Identifying risk factors for central pontine and extrapontine myelinolysis after liver transplantation : a case-control study", Neurocrit Care, 20, pp.287~295 (2014)
  127. Alukal JJ, "Hyponatremia in cirrhosis : an update", Am J Gastroenterol, 115, pp.1775~1785 (2020)
  128. Brinson EL, "Desmopressin reverses overly rapid serum sodium correction in a hyponatremic patient undergoing living donor liver transplantation : a case report", A A Pract, 11, pp.82~84 (2018)
  129. Praharaj DL, "Clinical implications, evaluation, and management of hyponatremia in cirrhosis", J Clin Exp Hepatol, 12, pp.575~594 (2022)

관련 논문AI추천

The Association Between the Serum Sodium Level and the Severity of Complications in Liver Cirrhosis김경아, 김남훈, 김종훈, 문영수, 배원기, 이석현, 이준성대한내과학회 · The Korean Journal of Internal Medicine2009 · 제24권 제2호Evaluation and management of hypernatremia in adults: clinical perspectives김세중, 백선하, Giae Yun대한내과학회 · The Korean Journal of Internal Medicine2023 · 제38권 제3호Evaluating and Managing Hyponatremia유민욱, Evelyn Bediako, Ozan Akca대한중환자의학회 · Acute and Critical Care2008 · 제23권 제2호Letter regarding “Evidence-based hyponatremia management in liver disease”Daphne J. Theodorou, Ioannis V. Mitselos, Stavroula J. Theodorou대한간학회 · Clinical and Molecular Hepatology2023 · 제29권 제4호Correspondence on Letter regarding “Evidence-based hyponatremia management in liver disease”백선하, Ji Young Ryu, Sejoong Kim대한간학회 · Clinical and Molecular Hepatology2023 · 제29권 제4호Effectiveness and Safety of Tolvaptan for the Management of Hyponatremia: Risk of Inadvertent Overcorrection김주신, 박미선, 박성주, 박승용, 범진선, 안효초, 이흥범한국병원약사회 · 병원약사회지2018 · 제35권 제4호

이 간행물의 다른 논문 (22건)

Critical appraisal of metabolic dysfunction-associated steatotic liver disease: Implication of Janus-faced modernityJoon Ho Moon, 김원, Gi-Ae Kimpp. 831-843Waiting for the changes after the adoption of steatotic liver disease전대원, Eileen L. Yoonpp. 844-850Hepatitis B core-related antigen: A novel and promising surrogate biomarker to guide anti-hepatitis B virus therapyTakako Inoue, Yasuhito Tanaka, Takehisa Watanabepp. 851-868Safety considerations for withdrawal of nucleos(t)ide analogues in patients with chronic hepatitis B: First, do no harmYao-Chun Hsu, Jia-Horng Kao, Cheng-Hao Tsengpp. 869-890Hepatorenal syndrome: Current concepts and future perspectivesChan-Young Jung, Jai Won Changpp. 891-908
원문 보기