The mechanism of sodium retention in cirrhosis of the liver with ascites: the effect of acetazolamide (diamox) on urinary electrolytes.

Abstract

SummaryAcetazolamide is shown to increase the urinary excretion of sodium and the sodium to potassium ratio in seven normal subjects and five cirrhotic patients without ascites. In seven cirrhotic patients with ascites the urinary output of sodium and the sodium to potassium ratio were low initially, and were unchanged by acetazolamide.The subjects with ascites had no evidence of renal disease, and the failure to excrete sodium must be attributed to an extrarenal factor. These observations are compatible with the hypothesis that there is an excessive secretion of aldosterone, though they do not indicate the cause. It is not necessarily lowering of plasma sodium level, as the abnormality of sodium and potassium excretion was also noted in one subject with a high normal plasma level. Liver disease also is not essential, as similar sodium retention occurred in one subject whose ascites was due to extrahepatic portal hypertension.Acetazolamide is found not to be a good diuretic in patients suffering from liver disease.