Disorders of Extracellular Fluid Volume: Cirrhosis of the Liver Mnemonics

Question 1

What does the mnemonic ‘NO EDEMA’ stand for in the context of Na⁺ and water retention in cirrhosis?

Answer 1

N: Nitric Oxide (↑) → Vasodilation
O: Overfill theory (Na⁺ retention precedes ascites)
E: Effective Arterial Blood Volume (↓ EABV)
D: Diuretics resistance (refractory ascites)
E: Endotoxins & prostaglandins (splanchnic vasodilation)
M: Maldistribution of fluid (Starling forces imbalance)
A: Aldosterone & ADH (↑ activation)

Question 2

What are the ‘3 A’s of Ascites’ in cirrhosis?

Answer 2

1. Arterial vasodilation (↓ EABV)
2. Aldosterone (↑ Na⁺ retention)
3. ADH (↑ water retention → hyponatremia)

Question 3

What does the mnemonic ‘U-P-O’ represent regarding theories of ascites formation?

Answer 3

U: Underfill theory (ascites → Na⁺ retention)
P: Peripheral vasodilation theory (↓ EABV → Na⁺ retention)
O: Overfill theory (Na⁺ retention → ascites)

Question 4

What are the treatment steps for ascites (Grade 2/3) summarized by the mnemonic ‘SALT DROP’?

Answer 4

S: Salt restriction (<2 g/day)
A: Aldosterone antagonist (spironolactone)
L: Loop diuretic (furosemide added if needed)
T: Torasemide (alternative to furosemide)
D: Daily weight monitoring
R: Ratio 100:40 (spironolactone:furosemide)
O: Oral fluid restriction (if Na⁺ <130 mEq/L)
P: Paracentesis (for Grade 3 + albumin infusion)

Question 5

What complications are associated with paracentesis as summarized by the mnemonic ‘POST-PARACENTESIS’?

Answer 5

P: Post-paracentesis circulatory dysfunction (PPCD)
O: Oliguria/kidney failure
S: Sodium drops (hyponatremia)
T: Thirst (ADH-driven)
P: Plasma expanders needed (albumin > saline)

Question 6

What does a spot urine Na⁺/K⁺ ratio of <1 indicate?

Answer 6

Spironolactone responsive

Question 7

What does a spot urine Na⁺/K⁺ ratio of >1 indicate?

Answer 7

Furosemide preferred

Question 8

What does a spot urine Na⁺/K⁺ ratio of <2.5 indicate?

Answer 8

Diuretic resistance