Hyponatremia in cirrhosis

1. Hyponatremia is common in patients with cirrhosis and ascites, and stems from splanchnic vasodilation, which lowers effective arterial blood volume and triggers the RAAS system, sympathetic nervous system, and non-osmotic release of ADH.

2. Assessment of hyponatremia should include chronicity, symptoms, and volume status.In patients with cirrhosis, evaluate for common causes of hypovolemia such as diuretic use, lactulose use, or recent large volume paracentesis.

3. Patients with cirrhosis are considered high risk for osmotic demyelination syndrome, and comorbid alcohol use disorder, potassium depletion, and malnutrition convey additional risk. Goal correction is reduced from 4-8 mEq/L per day to 4-6 mEq/L per day.

4. Hyponatremia is a poor
prognostic marker in cirrhosis and has been incorporated into the MELD-Na score. Hyponatremia is associated with higher rates of complications such as hepatic encephalopathy, spontaneous bacterial peritonitis, and hepatorenal syndrome.    

summary of the 2026 AGA Clinical Practice update on surveillance of metaplastic and premalignant conditions of the oesophagus and colorectum in older adults

✴️ Asian Neurogastroenterology and Motility Association and Asia-Pacific Association of Gastroenterology Chronic Constipation Consensus 2026

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