Hyponatremia in Cirrhosis

Clin Liver Dis. 2022 May;26(2):149-164. doi: 10.1016/j.cld.2022.01.001. Epub 2022 Apr 1.


Hyponatremia is the most common electrolyte disorder encountered in clinical practice, and it is a common complication of cirrhosis reflecting an increase in nonosmotic secretion of arginine vasopressin as a result of of the circulatory dysfunction that is characteristic of advanced liver disease. Hyponatremia in cirrhosis has been associated with poor clinical outcomes including increased risk of morbidity and mortality, poor quality of life, and heightened health care utilization. Despite this, the treatment of hyponatremia in cirrhosis remains challenging as conventional therapies such as fluid restriction are frequently ineffective. In this review, we discuss the epidemiology, clinical outcomes, pathogenesis, etiology, evaluation, and management of hyponatremia in cirrhosis.

Keywords: Albumin; Arginine vasopressin; Ascites; Central pontine myelinolysis; Cirrhosis; Hyponatremia; Liver transplantation; Osmotic demyelination syndrome.

Publication types

  • Review
  • Research Support, N.I.H., Extramural

MeSH terms

  • Humans
  • Hyponatremia* / epidemiology
  • Hyponatremia* / etiology
  • Hyponatremia* / therapy
  • Liver Cirrhosis
  • Quality of Life