Abstract
INTRODUCTION: Hypervolemic hyponatremia due to cirrhosis is caused by an increment in total body water (TBW) in excess of an increase in total exchangeable sodium (Na(+)) and potassium (K(+)). Therefore, therapy is aimed at treating not only the hyponatremia but there is an additional requirement to treat the volume overload. METHODS: Correction of cirrhosis-associated hyponatremia can be achieved by ensuring that the negative water (H(2)O) balance is in excess of the negative Na(+) and K(+) balance. This therapeutic approach can be attained by administering intravenous 3% sodium chloride (NaCl) and furosemide. RESULTS: Presently, there is no quantitative method for predicting the volume of IV 3% NaCl required to be infused in conjunction with furosemide that satisfies this therapeutic goal. Therefore, based on the empirical relationship between the plasma Na(+) concentration and exchangeable Na(+), K(+), and TBW, a new formula is derived to calculate the volume of IV 3% NaCl required to raise the plasma Na(+) concentration ([Na(+)](p1)) to a targeted level ([Na(+)](p2)) by attaining the desired amount of negative Na(+), K(+,) and H(2)O balance. CONCLUSION: This new equation is the first quantitative approach for treating hypervolemic hyponatremia by attaining a negative H(2)O balance in excess of negative Na(+) and K(+) balance. This formula is particularly useful in the treatment of cirrhosis-associated hyponatremia where there are limited therapeutic options.