Published online Nov 7, 2015. doi: 10.3748/wjg.v21.i41.11584
Peer-review started: May 11, 2015
First decision: July 13, 2015
Revised: August 8, 2015
Accepted: September 15, 2015
Article in press: September 15, 2015
Published online: November 7, 2015
Core tip: Dilutional hyponatremia is a frequent complication with high morbidity and mortality in advanced liver cirrhosis with ascites. It is attributable to disturbed water excretion related to enhanced vasopressin activity on the background of underfilling state in the splanchnic arterial circulation. V2 receptor antagonist is theoretically promising for the future treatment of hyponatremia and ascites. The present review aimed to summarize the pathophysiological backgrounds of ascites and hyponatremia and to introduce major results of all controlled trials. Although there existed several unsolved problems and controversies on the topic, discussions from the basic standpoints may light up the dark road.