Sodium excretion in 13 patients with decompensated cirrhosis was measured under baseline conditions of water loading (n = 13) and during conditions designed to improve effective blood volume including: head-out water immersion alone (n = 13); norepinephrine infusion alone (n = 6), and combined norepinephrine and head-out water immersion (n = 6). All 13 patients were in positive sodium balance under baseline conditions, with a mean plasma aldosterone concentration of 78.7 f 15.6 ng per dl. In only four patients was plasma aldosterone less than 50 ng per dl. During head-out water immersion alone, 5 patients achieved negative sodium balance and, in all 5, plasma aldosterone was less than 50 ng per dl (mean = 23.0 f 5.3 ng per dl).
However, the mean plasma aldosterone during head-out water immersion in the eight patients who remained in positive sodium balance during this maneuver was 64.0 f 11.9 ng per dl (p e 0.01). During norepinephrine alone, positive sodium balance was maintained in all patients, and plasma aldosterone was not significantly different from baseline. Combining norepinephrine and head-out water immersion resulted in the largest and most consistent negative sodium balance. The mean plasma aldosterone concentration was decreased significantly (78.7 f 15.6 to 32.6 f 9.9 ng per dl (p < 0.06). Regardless of the maneuver performed, no patient in whom aldosterone exceeded 50 ng per dl achieved negative sodium balance. Furthermore, only in those