Hyponatremia is a common problem in patients with advanced cirrhosis and portal hypertension¹.The severity of the hyponatremia is related to the severity of the cirrhosis.It  is characterized by excessive renal retention of water relative to sodium due to reduced solute–free water clearance². The primary cause is increased release of arginine vasopressin. Hyponatremia is associated with increased mortality in cirrhotic patients, those with end–stage liver disease (ESLD) .Clinical evidence suggests that adding serum sodium to model for ESLD (MELD) scoring identifies patients in greatest need of liver transplantation by improving waiting list mortality prediction³.