Torsemide in Patients with Hepatic Disease with Cirrhosis and Ascites
As it has been mentioned, one of the primary targets of Torsemide is elimination of the accumulation of fluids in the body. It appears that renal dysfunction, quite a typical complication of diabetes, is often a pressing problem for patients with advanced liver disease. Particularly, alterations in renal physiology have proved to be closely connected with acute hepatic failure and some associated diseases such as cirrhosis and ascites.
Cirrhosis refers to any of progressive diseases of the liver characterized by the death of liver cells caused by inadequate diet, excessive alcohol consumption, chronic infection, etc. Most patients with cirrhosis of the liver concomitantly suffer from edema and ascites. Ascites is a disease which consists in the accumulation of serous fluid in the peritoneal cavity. Two factors are deemed important in the formation of ascites: an increased amount of body sodium and water, and increased sinusoidal portal pressure.
In general, ascites often develops as a complication of cirrhosis. Extracellular fluid accumulates in excessive quantities and over time the renal retention of sodium eventuates as clinically detectable ascites and edema. However, sometimes the development of ascites is related merely to the increased sodium intake and is indicative of salt loading but not of hepatic dysfunction per se.
Great caution is advised when Torsemide is used in patients with hepatic disease with cirrhosis and ascites because major alterations of fluid flow in the body and electrolyte balance may accelerate the development of acute hepatic failure and even lead to hepatic coma. In general, diuretic therapy in a patient with cirrhosis may be associated with a substantial risk of adverse side-effects that is why though loop diuretics, including Torsemide, are normally prescribed to treat edema, in case a patient is cirrhotic, the decision to start taking diuretics cannot and should not be automatic.
Usually in order to prevent hypokalaemia and metabolic alkalosis (acidosis), an aldosterone antagonist or potassium-sparing agents, such as spironolactone and amiloride, are used concomitantly with Torsemide. When taken together with aldosterone antagonists, Torsemide causes increases in sodium and fluid excretion in patients with ascites due to hepatic cirrhosis. In general, urinary excretion of sodium relative to the urinary excretion of Torsemide is less in cirrhotic patients than in healthy subjects. But at the same time cirrhotic patients demonstrate increased renal clearance of Torsemide. Therefore, these two factors countervail each other.
If a patient is diagnosed with hepatic disease, cirrhosis or ascites, it is highly recommended to initiate treatment with Torsemide in hospital under the supervision of specialists. It can be beneficial, but these diseases are serious enough for you to be very careful about taking any medication that can potentially aggravate your condition.