Hyponatremia : pathophysiology, treatment and prognostic value Summary of the discussion

Hyponatremia in cirrhosis, like in other diseases, has been generally considered as a minor clinical event with- out real repercussion on the physical and mental status of the patient. However, it has been demonstrated that mild hyponatremia (> 125 mEq/L) and even very mild hyponatremia (serum sodium level 127-132 mEq/L) is associated with an increased risk of falls, probably due to impairment of attention, posture and gait mecha- nisms (1). It was noted that in volunteers of similar age, after mild alcohol intake (0.55 g/kg body weight), atten- tion and gait tests were less affected (1). Patients with severe hyponatremia should be advised not to drive. Hyponatremia is also an independent prognosis factor in case of cirrhosis as pointed out by several recent studies and might be added to the MELD score in order to improve organ allocation in patients on the waiting list for liver transplantation.