{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:36:14Z","timestamp":1791333374147,"version":"4.3.1"},"reference-count":45,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","license":[{"start":{"date-parts":[[2018,11,1]],"date-time":"2018-11-01T00:00:00Z","timestamp":1541030400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"},{"start":{"date-parts":[[2018,11,8]],"date-time":"2018-11-08T00:00:00Z","timestamp":1541635200000},"content-version":"vor","delay-in-days":7,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Liver Transpl"],"published-print":{"date-parts":[[2018,11]]},"abstract":"<jats:p>Hyponatremia in cirrhosis is defined as a serum sodium level \u2264130 mEq\/L and occurs in approximately 22% of patients with cirrhosis. The appearance of hyponatremia in patients with cirrhosis portends a poor prognosis before liver transplantation (LT), independent of the Model for End\u2010Stage Liver Disease (MELD) score. With the development of the MELD\u2010sodium score, the management of hyponatremia has become more relevant than ever before. Overcorrection of hyponatremia before LT or perioperatively can lead to the devastating neurologic condition known as osmotic demyelination syndrome, which is often irreversible and fatal. Therefore, the most important tenet of hyponatremia is to avoid correcting the serum sodium by \u22658 mEq\/L in a 24\u2010hour period. Treatment of hyponatremia is highly challenging. The vast majority of patients with cirrhosis have chronic hypervolemic hyponatremia. Fluid restriction increases serum sodium levels, but tolerance and compliance are significant barriers. Diuretic withdrawal is helpful but contributes to worsening fluid overload. There are limited data to support use of intravenous concentrated albumin solutions. The use of the arginine vasopressin antagonists (\u201cvaptans\u201d) is contentious; however, they may have a limited role. Risk factors for intraoperative overcorrection of serum sodium include increased utilization of packed red blood cell and fresh frozen plasma transfusions, which are often unavoidable. Intraoperative management is evolving, and more data are needed in regard to the use of sodium\u2010reduced continuous venovenous hemofiltration and the use of trishydroxymethylaminomethane (Tris) to avoid excess sodium rebound. A thorough discussion of the current treatment options before and during LT is given in this review.<\/jats:p>","DOI":"10.1002\/lt.25327","type":"journal-article","created":{"date-parts":[[2018,8,22]],"date-time":"2018-08-22T15:38:54Z","timestamp":1534952334000},"page":"1612-1621","source":"Crossref","is-referenced-by-count":31,"title":["Hyponatremia in Cirrhosis: Implications for Liver Transplantation"],"prefix":"10.1097","volume":"24","author":[{"given":"Michael","family":"Leise","sequence":"first","affiliation":[{"name":"Department of Gastroenterology and Hepatology,Mayo Clinic,Rochester,MN"},{"name":"William J. von Liebig Center for Transplantation and Clinical Regeneration,Mayo Clinic,Rochester,MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0764-7873","authenticated-orcid":false,"given":"Andr\u00e9s","family":"C\u00e1rdenas","sequence":"additional","affiliation":[{"name":"GI\/Liver Unit,Institut de Malalties Digestives i Metab\u00f2liques, Hospital Cl\u00ednic, University of Barcelona,Barcelona,Spain"},{"name":"Institut d\u2019Investigacions Biom\u00e8diques August Pi Sunyer,Ciber de Enfermedades Hep\u00e1ticas y Digestivas,Barcelona,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2018,11,8]]},"reference":[{"key":"lt25327-bib-0001-20240115","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1002\/hep.510280337","article-title":"Hyponatremia in cirrhosis: from pathogenesis to treatment","volume":"28","year":"1998","journal-title":"Hepatology"},{"key":"lt25327-bib-0002-20240115","doi-asserted-by":"crossref","first-page":"1535","DOI":"10.1002\/hep.21412","article-title":"for CAPPS Investigators. 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