Treatment of Cirrhosis-Associated Hyponatremia Refractory to Vasopressin 2-Receptor Antagonist

Ajay Yadlapati, Arksarapuk Jittirat, Minhtri K. Nguyen


Hyponatremia in patients with cirrhosis is due to impaired water excretion from persistent release of antidiuretic hormone induced by diminished effective circulatory volume (ECV). The treatment of cirrhosis-associated hyponatremia is free water restriction and vasopressin-2-receptor antagonists (V2RAs). We report a cirrhotic patient with hyponatremia who failed to improve with V2RAs but corrected with treatment of hepatorenal syndrome (HRS). The failure of hyponatremia to improve with V2RAs was likely due to avid renal proximal Na+ and H2O reabsorption from decreased ECV, resulting in diminished fluid delivery to the collecting tubule. Midodrine and octreotide improved the systemic hemodynamics and increased distal fluid delivery resulting in resolution of hyponatremia. To date, this is the first case report of a cirrhotic patient with hyponatremia refractory to V2RAs that resolved with treatment of HRS.

J Med Cases. 2014;5(5):264-266


Hyponatremia; Cirrhosis; Vasopressin receptor antagonist

Full Text: HTML PDF

Browse  Journals  


Journal of Clinical Medicine Research

Journal of Endocrinology and Metabolism

Journal of Clinical Gynecology and Obstetrics


World Journal of Oncology

Gastroenterology Research

Journal of Hematology


Journal of Medical Cases

Journal of Current Surgery

Clinical Infection and Immunity


Cardiology Research

World Journal of Nephrology and Urology

Cellular and Molecular Medicine Research


Journal of Neurology Research

International Journal of Clinical Pediatrics



Journal of Medical Cases, monthly, ISSN 1923-4155 (print), 1923-4163 (online), published by Elmer Press Inc.                     
The content of this site is intended for health care professionals.
This is an open-access journal distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License, which permits unrestricted
non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Creative Commons Attribution license (Attribution-NonCommercial 4.0 International CC-BY-NC 4.0)

This journal follows the International Committee of Medical Journal Editors (ICMJE) recommendations for manuscripts submitted to biomedical journals,
the Committee on Publication Ethics (COPE) guidelines, and the Principles of Transparency and Best Practice in Scholarly Publishing.

website:   editorial contact:
Address: 9225 Leslie Street, Suite 201, Richmond Hill, Ontario, L4B 3H6, Canada

© Elmer Press Inc. All Rights Reserved.

Disclaimer: The views and opinions expressed in the published articles are those of the authors and do not necessarily reflect the views or opinions of the editors and Elmer Press Inc. This website is provided for medical research and informational purposes only and does not constitute any medical advice or professional services. The information provided in this journal should not be used for diagnosis and treatment, those seeking medical advice should always consult with a licensed physician.