Aldosterone Antagonist Dosing and the Risk of Hyponatremia in Patients With Cirrhosis and Ascites.

Abstract

Ascites is a common decompensating event in cirrhosis.1 For initial treatment, major liver societies recommend spironolactone 100 mg daily with or without furosemide 40 mg daily.2 Although supporting data are lacking, the generally accepted dosing ratio of spironolactone to furosemide is 5:2 so as to maintain potassium equilibrium.2 However, aldosterone antagonists are a common cause of hyponatremia because they induce natriuresis at the distal tubule and collecting ducts, leaving scant opportunity for sodium reabsorption.