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Cited by 46Liver Disease and TransplantationHeart Failure Treatment and ManagementElectrolyte and hormonal disorders

Review article: volume expansion in patients with cirrhosis

Henriksen, J. H., Kiszka‐Kanowitz, M., Bendtsen, F., Møller, S.·2002·Alimentary Pharmacology & Therapeutics
DOI 10.1046/j.1365-2036.16.s5.3.x
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Abstract

Summary: Adequate size and distribution of the circulating medium are important for cardiovascular function, tissue oxygenation, and fluid homoeostasis. Patients with cirrhosis have cardiovascular dysfunction with a hyperkinetic systemic circulation, abnormal distribution of the blood volume, vasodilation with low systemic vascular resistance, increased whole‐body vascular compliance, and increased arterial compliance. The effectiveness and temporal relations of plasma/blood volume expansion depend highly on the type of load (water, saline, oncotic material, red blood cells). Patients with cirrhosis respond in some aspects differently from healthy subjects, owing to their disturbed circulatory function and neurohormonal activation. Thus the increase in cardiac output and suppression of the renin‐angiotensin‐aldosterone system and sympathetic nervous system during volume expansion may be somewhat blunted, and in advanced cirrhosis, especially the non‐central parts of the circulation, including the splanchnic blood volume, are expanded by a volume load. Infusion of oncotic material (preferably albumin) is important in the prevention of post‐paracentesis circulatory dysfunction. In conclusion, volume expansion in advanced cirrhosis is qualitatively and quantitatively different from that of healthy subjects, and in those with early cirrhosis. Timely handling is essential, but difficult as it is a balance between the risks of excess extravascular volume loading and further circulatory dysfunction in these patients with a hyperdynamic, but hyporeactive, circulation.

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  • More convincing evidence for benefit of serum albumin infusion has been obtained in patients with tense ascites due to portal hypertension; it may preserve hemodynamic stability after draining ascites but increases risk of extravascular volume expansion.

    “More convincing evidence for the benefit of serum albumin infusion has been obtained in patients with tense ascites due to portal hypertension. This may preserve hemodynamic stability, which is at risk after draining substantial volumes of ascites, but increases the risk of extravascular volume expansion.160”

    From Hypoalbuminemia: Pathogenesis and Clinical Significance (2019) · cites this paper as [160]

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Authors
Henriksen, J. H., Kiszka‐Kanowitz, M., Bendtsen, F., & Møller, S.
Affiliations
University of Copenhagen (DK)
Corresponding author
Henriksen, J. H.
ORCID
Venue
Alimentary Pharmacology & Therapeutics
Publisher
Wiley
Published
2002-11-07
Volume
16
Issue
s5
Pages
12-23
ISSN
  • 0269-2813 (ISSN-L)
  • 1365-2036
DOI
10.1046/j.1365-2036.16.s5.3.x
OpenAlex
W2061882487
Cited by
46
References
97
Citations by year
2025: 2 · 2022: 2 · 2021: 1 · 2020: 3 · 2018: 5 · 2017: 5 · 2016: 2 · 2015: 1 · 2014: 2 · 2013: 1 · 2012: 2
FWCI
0.31
Type
journal article
Language
en
Open access
closed
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Alimentary Pharmacology & Therapeutics (publishedVersion)
  • PubMed (publishedVersion)
  • Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
Topics
  • Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Electrolyte and hormonal disorders
Keywords
liver cirrhosis, volume expansion, fluid resuscitation, plasma expansion, blood volume distribution, hyperkinetic circulation, albumin, renin-angiotensin-aldosterone system, sympathetic nervous system, fluid homeostasis
MeSH terms
Blood Volume, Fluid Therapy, Hemodynamics, Humans, Liver Cirrhosis, Plasma Substitutes, Serum Albumin

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