Hyponatremia in patients with liver cirrhosis has significant prognostic value. It correlates with hepatic encephalopathy and poor prognosis. Hyponatremia may be caused by type I and type II hepatorenal syndrome, furosemide, spironolactone, excessive volumes of glucosic infusions administrations and other reasons. Current treatment options for hyponatremia are limited. Treatment of hyponatremia in patients with cirrhosis includes sodium and fluid restriction and continued treatment with diuretics. An administration of diuretics can exacerbate the reduction in tissue perfusion that occurs in cirrhosis, further to impair the ability to excrete free water. Vasopressin receptor antagonists are newer therapies and their precise role in treating of hypervolemic hyponatremia is not well defined. Current pharmacologic approaches have focused directly on hyponatremia. New options for the management of ascites and hepatorenal syndrome could lower the high morbidity and mortality in these patients at risk.