Cirrhosis is frequently associated with hyponatremia and hypokalemia, either separately or concurrently. There are a variety of etiologies: ascitic fluid sequestration; attempts at diuresis, often superimposed on poor diet or sodium restriction; paracentesis therapy; and hemodilution. Electrolyte abnormalities are more likely to appear when ascites is present and are more severe if azotemia complicates liver disease. Hemodilution is a frequent finding in cirrhosis, especially with ascites; this may be due to increased activity of aldosterone, which is normally deactivated in the liver, or sometimes is attributable to inappropriate secretion of AVP (ADH).

Congestive heart failure is frequently associated with hyponatremia and much less frequently with hypokalemia. The most frequent cause of hyponatremia is overtreatment with diuretic therapy, usually in the context of dietary sodium restriction. However, sometimes the hyponatremia may be dilutional, due to retention of water as the glomerular filtration rate is decreased by heart failure or by inappropriate secretion of AVP (ADH). If hypokalemia is present, it usually is a side effect of diuretics.