Treatment of Chronic Liver Failure in Cirrhosis with Hypervolaemic Hyponatraemia (Serum Sodium <130 mmol/L)

Clinical Scenario

This protocol addresses patients with cirrhosis who develop hypervolaemic hyponatraemia — a serum sodium below 130 mmol/L — in the context of expanded extracellular fluid volume manifesting as ascites and peripheral oedema.

The combination of significant sodium dilution with fluid overload in a cirrhotic patient defines a distinct and clinically important management situation.

Management Approach (Partial)

The approach to this scenario involves measures to address the fluid imbalance directly, including a strategy of intake restriction. Adjunctive pharmacological support may also be considered, though available evidence remains limited.

Full regimen, sequencing, and dosing details are in the complete protocol →

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.jhep.2018.03.024

The second, most common, is characterised by an expansion of the extracellular fluid volume, with ascites and oedema.

Fluid restriction to 1,000 ml/day is recommended in the management of hypervolemic hyponatremia since it may prevent a further reduction in serum sodium levels (III;1).

Albumin administration can be suggested in hypervolemic hyponatremia, but data are very limited to support its use (II-3;2).

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