A note on hyponatremia in patients with cirrhosis 

Mechanism of action: Patients with cirrhosis develops systemic vasodilation causing activation of endogenous vasoconstrictors including antidiuretic hormone (ADH). ADH in return causes the water retention and subsequently hyponatremia. 

Clinical significance: Hyponatremia in patients with cirrhosis is a significant predictor of death. Also, hyponatremia is found to be associated with an increased risk of the central pontine demyelination and neurologic dysfunction after liver transplantation.



 References: 

1.  Biggins SW, Rodriguez HJ, Bacchetti P, et al. Serum sodium predicts mortality in patients listed for liver transplantation. Hepatology 2005; 41:32. 

2. Ruf AE, Kremers WK, Chavez LL, et al. Addition of serum sodium into the MELD score predicts waiting list mortality better than MELD alone. Liver Transpl 2005; 11:336. 

3. Kim WR, Biggins SW, Kremers WK, et al. Hyponatremia and mortality among patients on the liver-transplant waiting list. N Engl J Med 2008; 359:1018.