title: Hyponatremia in Patients with Cirrhosis of the Liver.
abstract: Hyponatremia is common in cirrhosis. It mostly occurs in an advanced stage of the disease and is associated with complications and increased mortality. Either hypovolemic or, more commonly, hypervolemic hyponatremia can be seen in cirrhosis. Impaired renal sodium handling due to renal hypoperfusion and increased arginine-vasopressin secretion secondary to reduced effective volemia due to peripheral arterial vasodilation represent the main mechanisms leading to dilutional hyponatremia in this setting. Patients with cirrhosis usually develop slowly progressing hyponatremia. In different clinical contexts, it is associated with neurological manifestations due to increased brain water content, where the intensity is often magnified by concomitant hyperammonemia leading to hepatic encephalopathy. Severe hyponatremia requiring hypertonic saline infusion is rare in cirrhosis. The management of asymptomatic or mildly symptomatic hyponatremia mainly rely on the identification and treatment of precipitating factors. However, sustained resolution of hyponatremia is often difficult to achieve. V2 receptor blockade by Vaptans is certainly effective, but their long-term safety, especially when associated to diuretics given to control ascites, has not been established as yet. As in other conditions, a rapid correction of long-standing hyponatremia can lead to irreversible brain damage. The liver transplant setting represents a condition at high risk for the occurrence of such complications.
authors.affiliation: Department of Clinical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, 40139 Bologna, Italy. mauro.bernardi@unibo.it.|Semeiotica Medica, Policlinico S. Orosla-Malpighi, Via Albertoni, 15, 40138 Bologna, Italy. mauro.bernardi@unibo.it.
authors.forename: Mauro
authors.initials: M
authors.lastname: Bernardi
authors.affiliation: Department of Clinical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, 40139 Bologna, Italy. carmenserena.ricci@hotmail.it.|Semeiotica Medica, Policlinico S. Orosla-Malpighi, Via Albertoni, 15, 40138 Bologna, Italy. carmenserena.ricci@hotmail.it.
authors.forename: Carmen Serena
authors.initials: CS
authors.lastname: Ricci
authors.affiliation: Department of Clinical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, 40139 Bologna, Italy. lucasanti@hotmail.it.|Semeiotica Medica, Policlinico S. Orosla-Malpighi, Via Albertoni, 15, 40138 Bologna, Italy. lucasanti@hotmail.it.
authors.forename: Luca
authors.initials: L
authors.lastname: Santi
keywords: Vaptans; hepatic encephalopathy; hyponatremia; liver  transplantation; liver cirrhosis