Fluid retention in patients with chronic liver disease: a critical evaluation of the factors responsible for the development of fluid retention in patients suffering from Laennec's cirrhosis of the liver, with reference to the inadequacies of commonly accepted theories, and including in particular the proposal of a new hypothesis with evidence in its support

Abstract

(1). The orthodox theories of the causes of fluid retention in patients with cirrhosis of the liver are discussed.

(2). Observations on the plasma level of albumin and globulin, and the colloid osmotic pressure exerted by them, in patients with cirrhosis of the liver with and without ascites are reported.

(3). Following treatment reaccumulation of ascitic fluid ceased in six patients with cirrhosis of the liver. Determinations of the level of plasma proteins and the colloid osmotic pressure thereby exerted performed at monthly intervals prior to the cessation of accumulation and for a period up to six months after it had occurred, do not support the contention that the level of plasma proteins is an important determinant in the development of ascites.

(4). The plasma colloid osmotic pressure is shown to be as low in patients without ascites as in those with it.

(5). The importance of considering the factors which modify renal excretion in a discussion of fluid retention is stressed.

(6). The presence of an antidiuretic substance in the urine of patients with liver disease and ascites is reported. The fact that its concentration varies with the extent of fluid retention is noted.

(7). The nature of the antidiuretic substance in the urine of patients with cirrhosis of the liver is discussed. Evidence is put forward to support the suggestion that it is the antidiuretic hormone of the posterior pituitary gland and criticisms that a similar substance reported in the urine of patients with eclampsia is not this hormone, are invalidated.

(8). Evidence is put forward to support the hypothesis that the antidiuretic substance present in the urine of patients with cirrhosis of the liver and water retention causes the delay in diuresis in hydrated rats by a specific kidney action.

(9). The chloruretic and antidiuretic properties of commercial pitressin are confirmed. It is shown that the latter is not affected when the pitressin is dialyzed. There is a considerable loss in chloruretic power with this procedure.