Ascites and hyponatremia in cirrhosis both arise from portal hypertension-induced splanchnic vasodilation, leading to reduced effective arterial blood volume and neurohormonal activation. Ascites represents the most common decompensating event in cirrhosis and is associated with significant morbidity and mortality, while hyponatremia independently predicts poor prognosis and transplant outcomes. This article outlines evidence-based diagnostic strategies and stepwise management, including dietary modification, diuretics, paracentesis, transjugular intrahepatic portosystemic shunt and transplant referral, as well as emerging therapies. These two conditions are interrelated, and multidisciplinary care is needed.