79 HYPONATREMIA IN CIRRHOSIS: A POSSIBLE ROLE OF ARGININ VASOPRESSIN

M.G.Chiappini, S.Gentile, S.Vulterini

Division of Medicine,Fatebenefratelli Hospital,lsola Tiberina,Boma,ltalia

Cirrhotic patients with ascites and peripheral edema are often,but not always,hyponatremic. The

mechanisms responsible for hyponatremia have not been clearly defined.To evaluate the possible

role of arginin vasopressin (AVP) in the development of hyponatremi@ in liver cirrhosis we ha-

ve studied 26 patients with ascites and edema (mean age 62~lO,range 50-80).16 out of them sho-

wed plasma sodium levels(PNa)higher(Grou p A)and ii lower(Group B)than 130 mmol/l.All patients

were on a normal sodium diet and diuretics were discontinued at least 7 days before the study. AVP,plasma renin activity(PRA),plasma aldosterone(PA)were determined by RIA in all patients.All

patients in Group B and 9 out of 15 in Group A showed plasma AVP levels above the values found

in 18 normal control subjects(mean value 2.9Z0.4 SEM pg/ml).Mean values(zSEM)of PNa,Urinary so-

dium excretion(UNa),plasma osmolality(Posm),AVP,PRA and PA are shown in the table.

Group A Group B P A positive correlation was found between AVP

PNa mmol/l 138.3~0.7 123.7Z3.0 <0.001 Posm mosm 285.8±1.6 264.9±i.0 <0.001 UNa mmol/day 84.4~12.3 7.2±9.0 <0.001 AVP pg/ml 5.9±0.6 9.0±0.8 <0.005 PRA ng/ml/h 1.8±0.9 6.7±1.4 (0.001 PA pg/ml 133.7±24.7 494.5±73.3 <0.001

and PA(r=O.47;p<O.O5),AVP and PRA(r=0.69; p<O.OOI),PRA and PA(r=O.66;p< O.O01).CONCLU- SIONS:l)Almost a l l c i r rho t ic patients with a- scites have abnormally high AVP levels;2)AVP levels are higher in pts with low PNa;3)PRA and PA are higher in pts with low PNaand UNB.

80 EPIDEMIOLOGY OF ACUTE HEPATITIS IN LYON. STUDY OF l 849 OUTPATIENTS

e. CHOSSEGROS (I)(2), P. CHEVALLIER (I), D, TREPO (2), T. FONTANGES (2),

Anti HA IgM -

C. TREPO (2), M. SEPETJAN (]), ([) Lab. de M~decine Preventive Facult~ de M~decine Rockefeller 69008 LYON France (2) INSERM U 271Laboratoire des H~patites Facult~ de M~decine Alexis Carrel 69372 LYON France

Over a period of 2 years (1982, 1983), we carried an hepatitis surveillance program of 1 ~00 000 urban people. 1 849 cases of" acute hepatitis were observed (incidence : 87/|0 J h). All of them were tested by R.I.A. for serological markers of HBV (HBs and HBe Ags, anti HBs, anti HBc and anti HBe) and by ELISA for anti HBc AgM and anti HA IgM. Delta Ag and antibody (R.I.A.) were tested only when HBs Ag was present.

Possibility of HBV association ? HBV - Anti HBc + Anti HBc + Anti HBc-

IgM + IgM - Ag HBs+ Ag HBs- Ag Has + Ag HBs -

216 || 41 52 433

Anti HA IgM + 3 1 18 5 4 I 0 1 8

HAV was the main cause of acute hepatitis (55.9 %) followed by NON-~ NON-B (20.4 %), HBV (12.5 %) and drug (4.3 %). A double infection by HBV and Delta agent was found twice.

Epidemiological differences between those four etiologies were observed for sex, age, racial origins, date of onset, location in the agglomeration and history of exposure.

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