Different Effects on Fluid Distribution between Tolvaptan and Furosemide in a Liver Cirrhosis Patient with Chronic Kidney Disease

Izumi Nagayama; Takahiro Masuda; Saki Nakagawa; Takuya Murakami; Ken Ohara; Ryo Matsuoka; Takahisa Kobayashi; Akito Maeshima; Tetsu Akimoto; Osamu Saito; Shigeaki Muto; Daisuke Nagata

doi:10.2169/internalmedicine.2174-18

CASE REPORTS

Different Effects on Fluid Distribution between Tolvaptan and Furosemide in a Liver Cirrhosis Patient with Chronic Kidney Disease

Izumi Nagayama, Takahiro Masuda, Saki Nakagawa, Takuya Murakami, Ken Ohara, Ryo Matsuoka, Takahisa Kobayashi, Akito Maeshima, Tetsu Akimoto, Osamu Saito, Shigeaki Muto, Daisuke Nagata

Author information

Izumi Nagayama
Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Japan
Takahiro Masuda
Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Japan
Saki Nakagawa
Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Japan
Takuya Murakami
Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Japan
Ken Ohara
Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Japan
Ryo Matsuoka
Department of Clinical Engineering, Jichi Medical University, Japan
Takahisa Kobayashi
Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Japan
Akito Maeshima
Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Japan
Tetsu Akimoto
Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Japan
Osamu Saito
Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Japan
Shigeaki Muto
Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Japan
Daisuke Nagata
Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Japan

Keywords: tolvaptan, furosemide, liver cirrhosis, bioimpedance analysis, extracellular water, intracellular water

JOURNAL OPEN ACCESS

2019 Volume 58 Issue 11 Pages 1587-1591

DOI https://doi.org/10.2169/internalmedicine.2174-18

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Details

Abstract

A 73-year-old man with liver cirrhosis and advanced chronic kidney disease was admitted to our hospital due to bilateral lower leg edema and appetite loss. Furosemide to treat fluid retention markedly decreased extracellular water compared with intracellular water, but the addition of tolvaptan equally decreased both with a greater diuretic response than furosemide alone. Furthermore, tolvaptan administration increased the plasma colloid osmotic pressure, which might facilitate the shift of fluid from the extravascular space to the intravascular space. This is the first case showing different effects on the fluid distribution between furosemide and additional tolvaptan in the same patient.

Corresponding author

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