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Saturday, November 28, 2015

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.


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.

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