From the Guidelines
A hypervolemic state is primarily caused by either excessive fluid intake or impaired fluid excretion, with common causes including heart failure, kidney failure, liver cirrhosis, and excessive intravenous fluid administration. This condition occurs when there is excessive fluid volume in the body's circulatory system, leading to fluid backup and potential complications. According to the most recent and highest quality study, hypervolaemic hyponatraemia is more common in cirrhosis, occurring due to non-osmotic hypersecretion of vasopressin and enhanced proximal nephron sodium reabsorption with impaired free water clearance 1.
Causes of Hypervolemia
- Heart failure: where the heart cannot effectively pump blood, leading to fluid backup in the body
- Kidney failure: which reduces the kidneys' ability to filter excess fluid
- Liver cirrhosis: which alters protein production and fluid distribution
- Excessive intravenous fluid administration in medical settings
- Certain medications like corticosteroids and NSAIDs that promote fluid retention
- Hormonal conditions such as Cushing's syndrome
- Excessive salt intake which draws water into the bloodstream
- Pregnancy: due to increased blood volume
Treatment of Hypervolemia
- Addressing the underlying cause
- Restricting fluid and sodium intake
- Using diuretics like furosemide (20-80mg daily) to increase urine output
- In severe cases, dialysis may be necessary to remove excess fluid
- According to the guidelines, vasopressin antagonists may be considered in the short term to improve serum sodium concentration in hypervolemic, hyponatremic states 1.
Pathophysiology of Hypervolemia
The body normally maintains fluid balance through complex mechanisms involving the kidneys, hormones like ADH and aldosterone, and the cardiovascular system, so disruption to any of these systems can lead to hypervolemia. Impaired free water clearance is observed in about 60% of patients with cirrhosis 1.
Clinical Considerations
- Many patients with advanced HF have symptoms that are related to the retention of salt and water 1
- In patients hospitalized with volume overload, including HF, who have persistent severe hyponatremia and are at risk for or having active cognitive symptoms despite water restriction and maximization of GDMT, vasopressin antagonists may be considered 1
- The prevalence of HF is between 2 and 3% and rises sharply at 75 years of age 1
From the Research
Causes of Hypervolemic State
- Excess total body sodium and water with expansion of extracellular fluid volume, which characterizes common disorders such as:
- Heart failure, which can lead to hypervolemic or euvolemic hyponatremia 3
- Liver cirrhosis, which can cause hypervolemic or euvolemic hyponatremia 3
- Syndrome of inappropriate antidiuretic hormone, which can lead to hypervolemic or euvolemic hyponatremia 3
- Acute congestive heart failure, which can be treated with hypertonic saline and furosemide 4
- Clinical congestion, which can influence worsening renal function after intravenous initiation of furosemide in patients with acute heart failure 5
- Cardiohepatic interactions, which can lead to the development of acute cardiogenic liver injury and congestive hepatopathy in heart failure, as well as cardiac dysfunction and failure in the setting of liver cirrhosis 6
Related Conditions
- Hyponatremia, which can be associated with heart failure, cirrhosis, or syndrome of inappropriate antidiuretic hormone 3
- Worsening renal function, which can occur after intravenous initiation of furosemide in patients with acute heart failure 5
- Liver disease, which can co-exist with heart failure and lead to complex cardiohepatic interactions 6