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Potassium metabolism and diuretics administration in liver cirrhosis
  1. P. Vesin

    Abstract

    The author first reviews, on the basis of personal and literature data, the main changes in three major parameters of potassium metabolism: serum potassium; daily urinary output of potassium; exchangeable potassium (Ke) at the three stages of the course of liver cirrhosis. The action of K-sparing diuretics (spironolactone, triamterene, amiloride) on these parameters is analysed. Although the introduction of these diuretics in our therapeutic armamentarium has resulted in a major advance, i.e. the quasi-total elimination of iatrogenic hypokalaemia and hypokalaemia-induced portacaval encephalopathy in the cirrhotic, the limits of their action on K metabolism are underlined: they may moderately enhance urinary K output; following cessation of their administration, a ‘rebound’ in urinary K output may be noted. Finally, Ke may still continue to decrease during their administration, indicating an aggravation of the underlying disease. It was also found that a rise in serum K and/or Ke during amiloride administration did not prevent the elevation of plasma renin activity usually induced by volume and/or Na depletion.

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