What Is Cirrhosis-Associated Hyponatremia?

When your liver is severely damaged, you can end up with cirrhosis that then contributes to hyponatremia, which is low blood sodium levels.

When your liver is damaged, your body repairs the damage by forming scar tissue. Scarring permanently affects your liver’s ability to do its job. When the scarring is severe, it’s called cirrhosis. Sometimes it’s called hepatic cirrhosis — “hepatic” just means having to do with your liver.

Cirrhosis can lead to the condition hyponatremia. Let’s break down the word:

• “hypo” means low
• “natrium” means sodium, or salt (think element Na)
• “emia” means relating to blood

So hyponatremia means your blood sodium levels are too low.

In this article, we’ll take a closer look at each of these two conditions and how they’re related.

The most common causes of cirrhosis are:

• hepatitis B virus (HBV)
• hepatitis C virus (HCV)
• alcohol-related liver disease (ARLD)
• nonalcoholic steatohepatitis (NASH)

When cirrhosis becomes severe, the scarring can make it difficult for blood to enter your liver through the portal vein. This leads to increased blood pressure in this vein, called portal hypertension.

In turn, portal hypertension can cause decreased kidney function. Fluid starts to build up in the abdominal space around your organs, causing a condition called ascites. It’s the most common complication of cirrhosis.

Because fluid, especially water, is being retained instead of released from your body, the sodium levels in your blood can become diluted until you have hyponatremia.

The symptoms of cirrhosis-associated hyponatremia can vary from person to person, and often they’re very general symptoms that could be associated with many conditions.

Frequently, your body is able to compensate for low sodium for a time, so your sodium levels might be low before you start to notice anything.

Symptoms tend to be more severe when sodium levels drop more quickly or when your sodium levels have been low for a prolonged period of time.

Common symptoms of cirrhosis-associated hyponatremia include:

More severe symptoms can also include:

When a severe case of cirrhosis-associated hyponatremia is left untreated, it can be fatal.

If a doctor thinks you might have cirrhosis-associated hyponatremia, the first test they’ll likely perform is a simple blood test called a basic metabolic panel. The results will show how much sodium is in your blood (serum sodium).

You have hyponatremia if your serum sodium levels are below 135 milliequivalents per liter (mEq/L), but lower levels can describe the severity:

• mild-to-moderate: 120 to 135 mEq/L
• severe: less than 120 mEq/L

You can also expect to provide a urine sample for testing. This will show how much sodium is exiting your body to help determine the cause of your hyponatremia.

You might also undergo:

• liver function test
• chest X-ray
• CT scan of your chest or head

If you haven’t previously been diagnosed with cirrhosis and your doctor believes that’s the cause of your hyponatremia, you could need additional tests, including:

Hyponatremia can be difficult to treat when combined with liver cirrhosis.

If you’re taking any diuretics, you’ll probably need to stop. You might also need to restrict your fluid intake.

Other treatments still need to be studied more and might be of limited benefit or even detrimental in some cases. These treatments can include:

• potassium (orally or intravenously)
• albumin
• hypertonic saline
• vasopressin receptor antagonists (vaptans)

If hyponatremia with liver cirrhosis can’t be controlled, you might need a liver transplant.

If you’ve already been diagnosed with cirrhosis, ask your doctor about how you might prevent hyponatremia and what to watch out for.

Seek medical attention if you notice difficulty urinating, lack of urination, or if you notice fullness in your abdomen that you think might be the start of ascites.

Mental effects of hyponatremia, such as confusion, or a loss of consciousness, are a medical emergency.

In general, the outlook for hyponatremia is better the less severe it is. Very severe hyponatremia can be fatal if it’s not addressed.

Mortality rates are sometimes used to describe what percentage of people die (from all causes, natural or otherwise) after a specified period of time after being diagnosed with a certain condition.

One Turkish study found that people with very severe hyponatremia (115 mEq/L or less) had an in-hospital mortality rate of 12.4%.

If you have ascites, the mortality rate is 15% after 1 year and 44% after 5 years.

The 10-year survival rate (meaning that a person is still alive 10 years after diagnosis) for cirrhosis is 47%.

Here are some brief answers to other questions you may have about cirrhosis-associated hyponatremia.

What type of hyponatremia is associated with cirrhosis?

Hyponatremia can be divided into three different types:

• hypervolemic
• euvolemic
• hypovolemic

About 90% of hyponatremia cases in people with cirrhosis are hypervolemic.

Why does hyponatremia occur in ascites?

Ascites is the result of your body retaining too much fluid. As you continue to drink fluids, the concentration of sodium in your blood gets diluted. When this level decreases too much, it’s called hyponatremia.

How does cirrhosis cause electrolyte imbalance?

Cirrhosis can lead to portal hypertension, and your body can respond by opening up your blood vessels across your body. This decrease in blood pressure leads to many hormonal changes that can affect how your body handles electrolytes. Sodium is one of these electrolytes.

Why is there hyponatremia in hepatic encephalopathy?

Hepatic encephalopathy is a type of brain dysfunction caused by a buildup of toxins when your liver isn’t working, such as with cirrhosis. The exact connection isn’t fully understood, but hyponatremia tends to increase your risk and severity of hepatic encephalopathy.

Cirrhosis is the buildup of scar tissue on your liver that affects its ability to properly function. This can lead to other complications like portal hypertension and ascites. These complications can eventually lead to hyponatremia, or a low blood sodium concentration.

The symptoms of hyponatremia can come on rapidly and might not be noticeable until they’re severe.

Cirrhosis-associated hyponatremia can be difficult to treat. If you think you might be experiencing this combination of conditions, seek medical attention.

Last medically reviewed on April 11, 2023