Q: 44 year old male is admitted to ICU for probable liver transplantation. On arrival in ICU lab work showed Sodium of 124 meq/L. You next plan

A) Do not treat
B) Administer normal isotonic saline
C) Administer hypertonic saline
D) Repeat sodium again to re-confirm the value
E) Administer Tolvaptan


Answer:  C

Treatment with hypertonic saline is strongly recommended in patients who arrive in ICU for liver transplantation and found to have severe hyponatremia. But care should be taken to avoid rapid correction as it may cause central pontine and extrapontine myelinolysis, and partial correction is recommended. Restoration of liver function following liver transplant corrects previously and partially corrects hyponatremia, and found to provide survival benefit.

To note, (Choice E) Tolaptan is strongly discouraged in cirrhosis patient due to its effect on kidney, causing renal failure.


References:

1. Yun BC, Kim WR, Benson JT, et al. Impact of pretransplant hyponatremia on outcome following liver transplantation. Hepatology 2009; 49:1610.