COMPARATIV EEFFECTS OF SPIRONOLACTONE AND COMBINATION WITH FUROSEMIDE OF ASCITES FLUID AND BLOOD ELECTROLYTE IN CIRRHOSIS
Objective: This study was to compare the effects of spironolactone and combination with furosemide on blood electrolyte levels and ascites fluid in patients with cirrhosis. [G1]Â
Methods: This research was undertaken with prospectively experimental analysis on a limited population in DR. M Djamil General National Hospital, Padang. We include 11 patients with spironolactone used and 13 patients with combination spironolactone-furosemide utilized.
Results: The percentage of patients who experienced blood electrolyte disturbances with the use of spironolactone was hyponatremia 72.72%, hypernatremia 0%, hypokalemia 45.45%, hyperkalemia 9.09%, hypocalcemia 9.09%, hypercalcemia 18.18%. The percentage of blood electrolyte disturbances on the use of a combination of spironolactone-furosemide hyponatremia was 100%, hypernatremia 0%, hypokalemia 23.07%, hyperkalemia 7.69%, hypocalcemia 15.38%, hypercalcemia 0%. A reduction in body weight and abdominal circumference patients before and after use of spironolactone-furosemide combination is significant (p=0.000). [G2]Â [G3]Â
Conclusion: The effects of spironolactone and combination with furosemide to the blood electrolyte levels in this study showed that the highest percentage of impaired blood electrolyte is hyponatremia and hypocalcemia. Spironolactone-furosemide combination therapy for weight-loss and abdominal circumference better than the single use of spironolactone.
2. Sudoyo AW, Bambang S, Idrus A, Marcellus SK, Siti S. Buku Ajar Ilmu Penyakit Dalam. 4th ed. Jakarta: Pusat Penerbitan Departemen Ilmu Penyakit Dalam. Fakultas Kedokteran Universitas Indonesia; 2007.
3. Friedman SL. Liver fibrosis from bench to bedâ€side. J Hepatol 2003;38(Suppl):S38-S53.
4. Dipiro JT. Pharmacotherapy: A Pathophysiologic Approach. 6th ed. US: McGraw-Hill Companies; 2005.
5. Suzuki H, Stanley AJ. Current management and novel therapeutic strategies for refractory ascites and hepatorenal syndrome. QJM 2001;94:293-300.
6. Moore KP, Wong F, GinÃ¨s P. The management of ascites in cirrhosis: report on the consensus conference of the international ascites club. Hepatology 2003;38:258-66.
7. Runyon BA. Practice guidelines committee: american association for the study of liver diseases (AASLD). Management of adult patients with ascites due to cirrhosis. Hepatology 2004;39:841-56.
8. Angeli P, Wong F, Watson H, Gin`es P. The CAPPS Investigators. Hyponatremia in cirrhosis: results of a patient population survey. Hepatology 2006;44(6):1535-42
9. Sweetman. Martindale: The complete drug reference. London: Chicago Pharmaceutical Press; 2009.
10. Klutts JS, Scott MG. Physiology and disorders of Water, Electrolyte, and Acid-Base Metabolism In: Tietz Text Book of Clinical Chemistry and Molecular Diagnostics 4th ed. Vol. 1. Philadelphia: Elsevier Saunders Inc; 2006. p. 1747-75.
11. Sutadi SM. Sirosis Hepatitis, Internal Medicine of Medical Faculty Sumatera Utara University; 2003.
12. Katzung BG. Farmakologi dasar dan klinik. 8th ed. Jakarta: Salemba Medika; 2004.
13. Runyon BA. AASLD Practice Guidelines Committee. Management of adult patients with ascites due to cirrhosis: an update. Hepatology 2009;49:2087-107.
14. Sood, Rita. Ascites: Diagnosis and Management. J Indian Acad Clin Med 2004;5(1):81-8.
15. Moore KP, Aithal GP. Guidelines on the management of ascites in cirrhosis. Gut 2006;55(Suppl VI): vi1â€“vi12.
16. James SD, Anna SF, Lok AK, Burroughs E, Jenny H. Sherlockâ€™s Diseases of the Liver and Biliary System. 12th ed. Edited by Blackwell Publishing Ltd; 2011.
17. Santos J, Planas R, Pardo A. Spironolactone alone or in combination with furosemide in the treatment of moderate ascites in nonazotemic cirrhosis. A randomized comparative study of efficacy and safety. J Hepatol 2003;39:187â€“92.
18. Angeli P, Fasolato S, Mazza E. Combined versus sequential diuretic treatment of ascites in nonazotemic patients with cirrhosis: results of an open randomized clinical trial. Gut 2010;59:98â€“104.
19. Vlachogiannakos J, Tang AKW, Patch D. Angiotensin converting enzyme inhibitors and angiotensin II antagonists as therapy in chronic liver disease. Gut 2001;49:303â€“8.
20. Planas R, Montoliu S, Balleste B. Natural history of patients hospitalized for management of cirrhotic ascites. Clin Gastroenterol Hepatol 2006;4:1385â€“94.
21. Gentilini P. Update on ascites and hepatorenal syndrome. Dig Liver Dis 2002;34:592-605.