Hyponatremia occurs when sodium levels in the body are below the typical level. It may develop in people living with cirrhosis, which is when scar tissue develops on the liver and replaces healthy tissue.

A person has hyponatremia if their serum sodium concentration level is less than 135 milliequivalents per liter (mEq/L). Serum is a clear liquid in the blood.

Sodium is a type of electrolyte. Electrolytes conduct electricity when dissolved in water. They are vital for several functions in the body.

Hyponatremia is the most common electrolyte disorder, affecting approximately 20–35% of hospitalized people.

People with cirrhosis have permanent liver damage as a result of scarring, which limits the organ’s ability to function. This can lead to liver failure as the condition progresses.

Researchers estimate cirrhosis affects around 1 in 400 adults in the United States.

This article discusses the symptoms, causes, treatment, and outlook for people with hyponatremia in cirrhosis. It also explores when someone should talk with a doctor.

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Symptoms of hyponatremia in cirrhosis vary depending on the severity of the condition but may include:

If a person has mild hyponatremia, they may not notice any symptoms.

Additionally, there is some crossover between the early symptoms of cirrhosis and hyponatremia, such as:

  • nausea
  • vomiting
  • feeling tired
  • weakness

Other early symptoms of cirrhosis may include:

A person may develop cirrhosis for many reasons. The most common causes of cirrhosis include:

In turn, cirrhosis may lead to hyponatremia.

When cirrhosis becomes severe, the scarring on the liver can make it difficult for the blood to enter the liver through the portal vein. This leads to high blood pressure in the portal vein, which healthcare professionals call portal hypertension.

This type of hypertension can also lead to a condition called ascites. It is the most common complication of cirrhosis. When a person has ascites, their body retains fluid, including water, in the body instead of releasing it.

This means sodium levels in a person’s blood may become increasingly diluted until they develop hyponatremia.

Additionally, the progression of ascites and cirrhosis can lead to a decline in kidney function. The kidneys are responsible for a range of bodily processes, which include balancing electrolyte and fluid levels.

Other common causes of hyponatremia that a person with cirrhosis may also experience include:

  • Kidney failure: Kidney failure may occur as kidney function declines and the kidneys cannot filter extra fluid from the body.
  • Congestive heart failure: A buildup of excess fluid in the body is one symptom of congestive heart failure.
  • Taking diuretics: These medications cause the body to release more sodium in the urine.
  • Taking antidepressants and pain medication: These medications may increase the amount a person sweats or urinates, causing a loss of sodium and fluid.
  • Severe vomiting or diarrhea: The body loses a lot of fluid and sodium with severe vomiting and diarrhea.
  • Excessive thirst: If a person drinks too much water, the fluid levels in their body increase, which can lead to a sodium imbalance.

There are several treatment options for hyponatremia depending on its cause and a person’s fluid status. Healthcare professionals aim to balance the water and sodium levels in the blood during treatment.

A person may need to stop taking diuretic medications. However, they should only do so with a doctor’s guidance. They may also need to reduce their fluid intake.

Other treatments for hyponatremia in cirrhosis may include:

  • Intravenous (IV) albumin infusion: A doctor may administer an albumin infusion through a vein to help temporarily expand the circulatory volume. This is the amount of fluid traveling through the cardiovascular system. Albumin is a protein that binds substances to help them travel through the bloodstream.
  • IV or oral potassium: Because potassium acts similarly to sodium as an electrolyte, administering potassium may also help increase someone’s sodium levels.
  • Vasopressin 2 receptor antagonists: This medication helps the kidneys remove large amounts of water through urine without reducing sodium, thus increasing serum sodium levels.

Doctors may administer hypertonic saline in certain situations. Healthcare professionals define hypertonic saline as any solution of sodium chloride (NaCl) in water with a concentration of NaCl higher than 0.9% weight by volume.

Experts do not recommend hypertonic saline as a long-term treatment for hyponatremia because it can lead to ascites and edema, or swelling due to fluid retention.

A person with advanced liver disease complicated with hyponatremia may require a liver transplant.

A person’s outlook depends on their individual circumstances, including:

  • severity of hyponatremia
  • severity of cirrhosis
  • overall health and whether they have other health conditions

People may also respond differently to treatments. Some may respond to IV infusions and medications but others may require a liver transplant.

Research from 2019 suggests that kidney dysfunction and hyponatremia are associated with a poor outlook.

A person can talk with their doctor to learn more about their outlook.

A person should visit a doctor if they experience any symptoms of hyponatremia or cirrhosis. With both conditions, a person may not notice any symptoms in the early stages or until the condition causes significant damage.

Therefore, people may benefit from regularly visiting a doctor to monitor their health. This is particularly recommended if they have any of the following conditions that are common causes of cirrhosis:

  • nonalcoholic fatty liver disease
  • alcoholic liver disease
  • chronic hepatitis B
  • chronic hepatitis C

A person can also talk with a healthcare professional if they notice any new or worsening symptoms, or if they notice any symptoms after taking medications, such as diuretics.

Hyponatremia is the most common electrolyte disorder. It may develop as a result of cirrhosis. People with cirrhosis may develop portal hypertension, which may lead to ascites and hyponatremia.

Treating hyponatremia in cirrhosis involves correcting the fluid and sodium imbalance in the body. A healthcare professional may administer medications or nutrients, like potassium, to help achieve this. Some people may require a liver transplant to treat severe cirrhosis.

A person with hyponatremia in cirrhosis should speak with their doctor about their individual outlook and treatment options.