Common complications of liver cirrhosis – management of hyponatremia |


Due to the disturbance of the body’s fluid balance, patients with liver cirrhosis (especially those in the decompensated stage) ) often presents with hyponatremia. Hyponatremia in cirrhosisrefers toserum sodium concentration <130 mmol/L. Hyponatremia in cirrhosis is a predictor of poor prognosis and is associated with important clinical outcomes, including increased mortality, increased risk of complications from cirrhosis, reduced quality of life, and increased healthcare burden, and its treatment remains challenging. This article reviews the clinical manifestations and management of hyponatremia in cirrhosis.

Clinical manifestations of hyponatremia in cirrhosis


There are two clinical types of hyponatremia in cirrhosis: hypovolemic hyponatremia and hypernatremia Hyponatremia. Most patients have hypervolemic hyponatremia, characterized by increased extracellular fluid and blood volume, with ascites and edema. In contrast, hypovolemic hyponatremia is usually absent of ascites and edema.

The clinical manifestations of hyponatremia in cirrhosis are not specific and depend primarily on In terms of the degree and speed of the decline in blood sodium levels, clinically, there are mainly inappetence, nausea, frequent vomiting, abdominal distension, fatigue, weight loss, apathy, decreased vision, decreased muscle tone, and weakened tendon reflexes.

When serum sodium≤115 mmol/L, the clinical symptoms are more obvious, manifested as fatigue, headache, muscle spasm, apathy, lethargy, mental Disorders, delirium, convulsions or coma, and even respiratory and cardiac arrest due to hyponatremic encephalopathy.

Management of Hyponatremia in Cirrhosis

Regarding the management of hyponatremia in cirrhosis, the 2018 European Association of Liver Diseases (EASL) clinical practice guidelines recommend the following:

  • Cirrhotic patients with hyponatremia have a poor prognosis, which is associated with increased mortality and morbidity. These patients should be evaluated for liver transplantation.

  • For the management of hypovolemic hyponatremia, removal of the cause and administration of normal saline is recommended.

  • For the management of hypervolemic hyponatremia, it is recommended to limit fluids to 1000 ml/d, with Prevent further reduction of blood sodium levels.

  • Hypertonic saline for the treatment of hypervolemic hyponatremia should be limited to rare cases with life-threatening complications cases, it may also be considered in patients with severe hyponatremia who are expected to undergo liver transplantation within a few days. Once symptoms subside, serum sodium concentrations should be slowly corrected (≤8 mmol/L per day) to avoid irreversible neurological sequelae such as osmotic demyelination.

  • Albumin therapy can be used in patients with hypervolemic hyponatremia, but supporting data are very limited.

  • Currently, vaptans (a class of selective non-peptidic arginine plus The use of vasopressin receptor antagonists) should be limited to controlled clinical studies.


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