Cirrhosis and hyponatremia: A review of pathogenesis, clinical relevance, and management.

Abstract

This narrative review examines the prognostic significance of sodium levels in cirrhosis. Clinical findings such as ascites typically develop between 5 and 10 years post-diagnosis, often with dysregulated sodium balance. About 50 % of cirrhosis patients develop hyponatremia, linked to poor prognosis, necessitating effective assessment and management. Hyponatremia arises from splanchnic vasodilation, causing fluid accumulation and reduced effective arterial volume, which triggers adaptive responses that worsen water retention and sodium imbalance. Ascitic fluid contains significant sodium stores, and its levels closely approximate serum values, suggesting that measuring ascitic sodium during therapeutic paracentesis might reduce the need for serum sampling. Management strategies include fluid restriction, vaptans, and albumin infusions, particularly in patients with acute kidney injury and ascites. Although pleural and peritoneal fluid analyses are routine, sodium levels are usually not measured despite their clinical relevance. This review addresses the pathophysiology, clinical implications, and management of hyponatremia in cirrhosis, focusing on patients with ascites or hepatic hydrothorax.