Frequency of Electrolyte Abnormalities in Cirrohsis Patient Presenting with Hepatic Encephalopathy

Abstract

Background: Liver cirrhosis is a chronic progressive liver disease which can develop into several complications such as hepatic encephalopathy. Hepatic encephalopathy (HE) is a serious neuropsychiatric complication of liver dysfunction that is often triggered by infection, gastrointestinal bleeding, constipation, renal insufficiency and electrolyte imbalance. Severe disease and further deterioration of cerebral function may occur in patients with cirrhosis due to electrolyte disturbances, particularly hyponatremia and hypokalemia. Objective: To determine the frequency of electrolyte abnormalities among cirrhosis patients presenting with hepatic encephalopathy. Methods: This descriptive cross-sectional study was conducted at Lahore General Hospital, Lahore, Pakistan from January 2025 to June 2025. There were 75 patients who had a diagnosis of liver cirrhosis and hepatic encephalopathy. A structured proforma was used to record demographic data, clinical history, aetiology of cirrhosis, grade of hepatic encephalopathy, precipitating factors and hospital outcomes. Blood samples were taken on admission for renal function tests, liver function tests, INR, serum sodium, serum potassium, serum chloride, serum calcium, and serum magnesium. An electrolyte abnormality was present if any electrolyte level in the serum was outside the laboratory normal reference range. The analysis of data was carried out by SPSS version 25. Qualitative variables were presented in terms of frequencies and percentages, and quantitative variables were presented as mean and standard deviation. With a p value less than 0.05 it was deemed to be statistically significant. Results: The mean age of patients was 52.6 ± 11.4 years. Out of 75 patients, 48 (64.0%) were males and 27 (36.0%) were females. Most patients had advanced liver disease, with 40 (53.3%) patients classified as Child-Pugh class C. Grade II hepatic encephalopathy was the most common presentation, observed in 30 (40.0%) patients. Overall, 56 (74.7%) patients had at least one electrolyte abnormality. Hyponatremia was the most frequent abnormality, present in 42 (56.0%) patients, followed by hypokalemia in 27 (36.0%), hypocalcemia in 20 (26.7%), and hypomagnesemia in 15 (20.0%) patients. Electrolyte abnormalities were significantly associated with higher grades of hepatic encephalopathy (p = 0.031) and increased in-hospital mortality (p = 0.046). Conclusion: Electrolyte abnormalities were highly frequent among cirrhosis patients presenting with hepatic encephalopathy. Hyponatremia was the most common abnormality, followed by hypokalemia. The presence of electrolyte imbalance was associated with more severe hepatic encephalopathy and poor hospital outcome. Routine assessment and timely correction of serum electrolytes should be part of the initial management of cirrhotic patients presenting with hepatic encephalopathy.