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閔獻基 中央醫學社 1962 中央醫學 Vol.2 No.5
Sodium and water metabolism in cirrhosis of the liver is quite variable and this disease is often complicated by the abnormal retention of sodium and water. This study is to elucidate the variable patterns of renal excretion of sodium and water, and to delineate the role of aldosterone in the development of intractable ascites by demonstrating the diuretic effects of SU 4885, an inhibitor of steroid biosynthesis and aldactone, a peripheral aldosterone antagonist. Examination of the daily urinary output of sodium and water in 20 cirrhotic patients showed that there were three definite patterns: namely, Pattern I , in which, both sodium and water excretions were markedly decreased; Pattern II , in which, in spite of markedly decreased sodium excretion, there appeared free water excretion, resulting in normal amount of urine; and Pattern III, in which, both sodium and water excretion were within normal limit. Sodium balance study in 4 cirrhotic patients also revealed positive, negative and normal balances indicating multiplicity of sodium metabolism Administration of SU4885 combined with prednisone resulted in marked sodium and water diuresis in 3 of 4 cirrhotic patient with intractable ascites. Reduced urinary excretin of Compound S noted during this regimen indicated blocking of 11β-hydroxylation in adrenal cortex and, indirectly, reduced production of aldosterone. Administration of aldactone alone or combined with prednisone likewise induced marked diuresis in 2 of 4 patients. Mercurial diuretics also showed some synergistic action with SU 4885 or aldactone. It is concluded that the excessive production of aldosterone plays a important role in the development of sodium and water retention in cirrhosis of the liver, and SU4885 and aldactone, if properly used, are effective diuretics in some of cirrhotic patients with intractable ascites.
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