8th July 2024

A 24-year-old man with liver cirrhosis as a result of alpha-1-antitrypsin deficiency is awaiting a liver transplant

A 24-year-old man with liver cirrhosis as a result of alpha-1-antitrypsin deficiency is awaiting a liver transplant. He presents to the acute medical unit with increasing nausea, he is not vomiting. Blood tests are taken and show a sodium of 125 mmol/L. He reports some minimal ankle oedema and worsening of ascites over the last 2 – 3 weeks, though his abdomen is not tense. He is otherwise systemically well. Physiology is unremarkable other than a mild tachycardia. Serum osmolality is 260 mmol/kg.

Which is the most likely cause of his hyponatraemia?

Select the SINGLE most appropriate option from the list below. Select ONE option only.