From the Guidelines

Hypocupremia is not mentioned in the provided evidence, however, hyponatremia is discussed in detail.

Hyponatremia is defined as a serum sodium concentration lower than 130 mmol/L, although reductions below 135 mmol/L should also be considered 1.

It is common in patients with advanced cirrhosis and has a poor prognosis, associated with increased mortality and morbidity, particularly neurological complications, and reduced survival after liver transplantation (LT) 1.
Both hypovolaemic and hypervolaemic hyponatremia can occur in patients with cirrhosis, with the latter being the most common, characterized by an expansion of the extracellular fluid volume, with ascites and oedema 1.

The treatment of hypovolemic hyponatremia consists of administration of sodium together with identification of the causative factor (usually excessive diuretic administration) 1.
The key to the management of hypervolemic hyponatremia is to induce a negative water balance with the aim of normalizing the increased total body water, which would result in an improvement of serum sodium concentration 1.
Vaptans, such as tolvaptan, are effective in improving serum sodium concentration in conditions associated with high vasopressin levels, such as the syndrome of inappropriate antidiuretic hormone secretion (SIADH), heart failure, or cirrhosis 1.
Tolvaptan is started with 15 mg/day and titrated progressively to 30 and 60 mg/day, if needed, according to changes in serum sodium concentration 1.

Hyponatremia is associated with increased risk of complications, including spontaneous bacterial peritonitis, hepatorenal syndrome, and hepatic encephalopathy 1.
The risk of complications increases significantly in patients with hyponatremia below 130 mmol/L and liver cirrhosis accompanied by ascites 1.

From the Research

Hypocupremia, or copper deficiency, is a condition that can cause various health problems, including neurological disorders and bone marrow failure 2.
It can be caused by a variety of factors, including gastric surgery, which can lead to malabsorption of copper 3, 4, 5.

Hypocupremia can cause a range of clinical manifestations, including cytopenias, bone marrow failure, and neurological symptoms such as myelopathy and peripheral neuropathy 2, 4, 5, 6.
The clinical manifestations of hypocupremia can be similar to those of vitamin B12 deficiency, making diagnosis challenging 2, 5, 6.

Diagnosis of hypocupremia typically involves measuring serum copper levels, which can be low in individuals with the condition 3, 4, 5.
Treatment of hypocupremia usually involves copper replacement therapy, which can help to resolve clinical manifestations and prevent long-term complications 4.

Individuals who have undergone gastric surgery are at increased risk of developing hypocupremia due to malabsorption of copper 3, 4, 5.
Other risk factors for hypocupremia may include dietary deficiencies and certain medical conditions that affect copper absorption 2, 6.

Hypercupremia, or copper toxicosis, can also cause neurological and other health problems, but the clinical manifestations and underlying pathophysiology may differ from those of hypocupremia 6.
A comparative study of patients with hypocupremia and hypercupremia found differences in clinical, laboratory, and electrodiagnostic findings, suggesting distinct underlying mechanisms 6.