# A New Quantitative Approach for Correcting Cirrhosis-Associated Hyponatremia by Inducing Negative Water Balance in Excess of Negative Sodium and Potassium Balance

## TL;DR

This paper introduces a new formula to treat cirrhosis-related low sodium levels by precisely balancing water and electrolyte loss.

## Contribution

The paper presents a novel quantitative formula to calculate the required dose of IV 3% NaCl for correcting cirrhosis-associated hyponatremia.

## Key findings

- A new formula was derived to calculate the volume of IV 3% NaCl needed to achieve a targeted plasma sodium concentration.
- The formula ensures a negative water balance exceeds the negative sodium and potassium balance, addressing cirrhosis-associated hyponatremia.
- This is the first quantitative method for treating this condition with limited therapeutic options.

## 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 (H2O) 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 H2O balance.

Conclusion: This new equation is the first quantitative approach for treating hypervolemic hyponatremia by attaining a negative H2O 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.