*Purpose: Numerous medications administered in the hospital setting may contain hidden/additional amounts of sodium in the drug itself and via intravenous (IV) diluents or admixtures. In patients with liver disease, sodium from these non-dietary sources can worsen ascites/edema, volume overload, diuretic resistance and potentially prolong hospitalization.

*Methods: To determine the frequency and extent of iatrogenic sodium overload, we evaluated patients with liver disease (defined as MELD score > 15) who were admitted to the inpatient hepatology service at University of Colorado Hospital with a dietary sodium restriction order between 1/1/18 to 1/1/20. We excluded patients who received normal saline or Lactated Ringers as IV volume expanding therapy or if they had a history of liver transplant. Our primary outcome was the amount of additional daily sodium intake from oral and IV medications and their associated diluents/admixtures during each hospitalization encounter.

*Results: A total of 258 encounters from 201 patients were included in the analysis. The median daily sodium content from non-dietary sources was 96 mg (interquartile range, 0-573.85 mg). The most common admitting diagnoses were: alcoholic cirrhosis (15.5%) and hepatic failure with coma (8.1%). The average length of stay was 7 days. There were 111 encounters (43%) where patients received no additional sodium from medications. Of the remaining 147 encounters, patients from 94 encounters (36.4%), 20 encounters (7.8%), and 33 encounters (12.8%) received an additional average daily sodium between 1 mg to 1000 mg, > 1000 mg to 2000 mg, and > 2000 mg, respectively. The primary source of iatrogenic sodium intake was from IV antimicrobials and associated diluents/admixtures. The most common sources of iatrogenic sodium in patients with an average of > 1000 mg/day were IV vancomycin, ceftriaxone, piperacillin/tazobactam, metronidazole, and meropenem.

*Conclusions: Our results indicate that iatrogenic sodium overload from medication sources is a frequent occurrence (20.6% of encounters received > 1000 mg of additional sodium from medications) in hospitalized patients with liver disease. Diligence should be taken to minimize use of very high sodium-containing antibiotics when appropriate and use lower sodium-containing infusion solutions. Future research is warranted to evaluate the impact of excess sodium on outcomes of patients on the liver transplant wait list.

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