Figure 2.

Therapeutic targets to treat hypervolemic hyponatremia in the setting of cirrhosis. As a result of splanchnic and systemic vasodilatation, the renin‐angiotensin‐aldosterone system and SNS are triggered and lead to increased sodium retention and the development of ascites. In addition, there is increased release of AVP, which results in significant water retention by the kidneys and the development of hyponatremia. Water restriction has been the mainstay of therapy, but other targets along this pathway may also provide benefits. Vasoconstrictors and infusions of albumin may improve the effective arterial blood volume (information is limited, and their use is not routinely recommended). Vaptans (V2 AVP receptor antagonists) prevent the binding of AVP to receptors in the kidneys and increase free water excretion.