Purpose of Review <p>Here is reviewed the epidemiology, pathophysiology, clinical impact and management strategies for hyponatremia in patients with cirrhosis.</p> Recent Findings <p>Hyponatremia in cirrhosis has many etiologies but is predominantly hypervolemic. The foundations of management include free water restriction and albumin infusion. Attempts should be made to increase solute intake, predominantly via increased protein. Vasopressor receptor antagonists (“vaptans”) are safe to use when clinically indicated. Hypertonic saline should be reserved for symptomatic patients or those requiring urgent correction of sodium prior to liver transplant. Other agents, including sodium-glucose co-transporter inhibitors, hold promise but require further study.</p> Summary <p>Hyponatremia is common in patients with cirrhosis and associated with significant morbidity and mortality. Treatment strategies are dictated by etiology, severity and acuity. This review covers the complex pathophysiology that precipitates hyponatremia in this setting and the multifaceted treatment approach that is required due to this complexity.</p>