Role of Salt Intake in the Management of Cirrhotic Ascites

Abstract

Background: The purpose of study was to determine the role of salt intake in the management
of ascites. Ascites is the most common complication of cirrhosis. Dilutional hyponatremia is
present in most of patients with ascites. It is due to excess in antidiuretic hormone which occurs
due to decrease in effective arterial volume. Water free salt intake tends to maintain the
circulatory volume by drawing the fluid from third space, hence inhibiting ADH. It also increases
the response of diuretics by increasing the filtered load of sodium. On the other hand, strict salt
restriction and diuretics worsen the hyponatremia and make ascites refractory to treatment.
Objective: To determine the role of salt intake in the management of ascites in cirrhotic patients.
Methods: It was an interventional experimental study. This study was conducted in Services
Hospital, Lahore. Sixty cirrhotic patients with ascites were randomized into two groups to undergo
treatment with diuretics and salt restriction during the day. One group (A) was advised salt intake
at night with over night fluid restriction, and the other group observed 24 hour salt restriction. The
comparison was done in respect to average reduction in weight and abdominal girth over 9 days.
Results: The average reduction in weight (p=0.011) and abdominal girth (p=0.003) was
significantly more in patients taking salt at night. Moreover these patients also maintained their
serum sodium levels (p=0.00001) and majority of them did not need increase in the dose of
diuretics or therapeutic ascitic tap.
Conclusion: Correction of dilutional hyponatremia by water free salt intake to improve the
response of diuretics, gives a safe and effective option for the management of ascites.