ALB and Hyponatremia: In the setting of LVP without albumin substitution, postparacentesis circulatory dysfunction (PPCD) occurs frequently and is most likely the result of effective blood volume reduction.13 PPCD is associated with AKI, hyponatremia, and decreased survival.25 Repeated low-volume paracentesis of 1.5 L/d or more might have led to a PPCD-like state over time and could explain the clinical observations in our cohort.