Natremia and liver transplantation: The right amount of salt for a good recipe

Figure 1 A simplified scheme including the sequential factors and the organs involved in hypervolemic hyponatremia onset, during cirrhosis, is depicted. ADH: Antidiuretic hormone; NO: Nitric oxide. ↑: Increase; ↓: Decrease.

Figure 2 Proposed algorithm for correction of severe hypervolemic hypernatremia in cirrhotic patients in wait of expedited liver transplantation. Indications are mainly desumed by small studies or on the base of expert opinion[74-78,86-89]. For vaptan, consider (1) the “off-label” indication and (2) the warning on tolvaptan liver toxicity limiting its use in patients with liver injury, in some countries. Acquisition of patient informed consent is suggested before treatment.