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Pathophysiology of hypervolemic hyponatremia in the setting of cirrhosis. In the setting of decompensated cirrhosis, significant vasodilatation of the splanchnic and systemic circulation leads to a reduction in the effective arterial blood volume. Consequently, multiple neurohumoral systems are activated and cause sodium and water retention as well as renal vasoconstriction. As a result, patients will develop refractory ascites, hyponatremia, and eventually hepatorenal syndrome.
