Hypokalemia and Hyponatremia in Hepatic Encephalopathy and Its Distribution Across Age, Gender, and Grade of Hepatic Encephalopathy: Hypokalemia and Hyponatremia in Hepatic Encephalopathy

Tamoor Iqbal

doi:10.54393/pjhs.v7i4.3690

Authors

Tamoor Iqbal Addu Equatorial Hospital, Addu, Maldives

DOI:

https://doi.org/10.54393/pjhs.v7i4.3690

Keywords:

Hepatic Encephalopathy, Hepatitis, Hypokalemia, Liver Cirrhosis

Abstract

Hepatic encephalopathy is a complication of cirrhotic liver disease precipitated by a variety of factors. One such factor is disturbance in the levels of sodium and potassium. Objectives: To determine the prevalence of hypokalemia and hyponatremia in patients of hepatic encephalopathy at a secondary care setting and its distribution in different age groups, gender, and grades of hepatic encephalopathy. Methods: This cross-sectional descriptive study with stratified analysis was held at the Department of Medicine, Tehsil Headquarter Hospital, Sarai Alamgir, Pakistan, from January 2024 to February 2025. In this study, a total of 127 patients who presented with hepatic encephalopathy were included. All these patients were assessed for the presence of hypokalemia and hyponatremia. Results: Mean age of hepatic encephalopathy sufferers was 50.64 ± 10.29 years. There were 87 (68.50%) male and 40 (31.50%) female patients. The most common cause of cirrhotic liver disease was the hepatitis C virus found in 62 (48.80%) patients. Prevalence of hypokalemia and hyponatremia in HE patients was 24 (18.90%) and 49 (38.60%), respectively. There was no significant difference in the prevalence of hypokalemia in age groups (p=0.609), gender (p=0.482), or grades of hepatic encephalopathy (p=0.902). Hyponatremia was significantly higher in older people (p=0.005) while there was no significant difference in its prevalence based on gender (p=0.824) or hepatic encephalopathy grade (p=0.621). Conclusions: Hypokalemia and hyponatremia are highly common in patients with hepatic encephalopathy presenting at a secondary care hospital.

References

Wang PL, Djerboua M, Flemming JA. Cause-Specific Mortality Among Patients with Cirrhosis in a Population-Based Cohort Study in Ontario (2000-2017). Hepatol Comm. 2023; 7(7): e00194. doi: 10.1097/HC9.0000000000000194. DOI: https://doi.org/10.1097/HC9.0000000000000194

Duo H, You J, Du S, Yu M, Wu S, Yue P et al. Liver Cirrhosis in 2021: Global Burden of Disease study. Plos One. 2025 Jul; 20(7): e0328493. doi: 10.1371/journal.pone.0328493. DOI: https://doi.org/10.1371/journal.pone.0328493

Dar AJ, John A, Ali A, Ansar A, Azam S. Chronic Liver Disease: Liver Cirrhosis and Diagnostic Features: Liver Cirrhosis and Diagnostic Features. Pakistan Journal of Health Sciences. 2023 Jan: 30-3. doi: 10.54393/pjhs.v4i01.511. DOI: https://doi.org/10.54393/pjhs.v4i01.511

Premkumar M and Anand AC. Overview of Complications in Cirrhosis. Journal of Clinical and Experimental Hepatology. 2022 Jul; 12(4): 1150-74. doi: 10.1016/j.jceh.2022.04.021. DOI: https://doi.org/10.1016/j.jceh.2022.04.021

Louissaint J, Deutsch-Link S, Tapper EB. Changing Epidemiology of Cirrhosis and Hepatic Encephalopathy. Clinical Gastroenterology and Hepatology. 2022 Aug; 20(8): S1-8. doi: 10.1016/j.cgh.2022.04.036. DOI: https://doi.org/10.1016/j.cgh.2022.04.036

Huang L and Han H. Diuretic Use in Patients with Cirrhosis and Complications of Portal Hypertension: Should We Rethink the Use of Furosemide as First Line? Clinical Liver Disease. 2024 Jan; 23(1): e0090. doi: 10.1097/CLD.0000000000000090. DOI: https://doi.org/10.1097/CLD.0000000000000090

Gankam Kengne F. Adaptation of the Brain to Hyponatremia and Its Clinical Implications. Journal of Clinical Medicine. 2023 Feb; 12(5): 1714. doi: 10.3390/jcm12051714. DOI: https://doi.org/10.3390/jcm12051714

Casey III B, Hofstrand R, Patel D, Bahekar A, Chapa-Rodriguez A. Hypokalemia-Induced Cardiac Arrest. Cureus. 2023 Feb; 15(2). doi: 10.7759/cureus.35034. DOI: https://doi.org/10.7759/cureus.35034

Younas A, Riaz J, Chughtai T, Maqsood H, Saim M, Qazi S et al. Hyponatremia and Its Correlation with Hepatic Encephalopathy and Severity of Liver Disease. Cureus. 2021 Feb; 13(2). doi: 10.7759/cureus.13175. DOI: https://doi.org/10.7759/cureus.13175

Singh Y, Nagar D, Singh M, Maroof M. Study of Electrolyte Disturbance in Chronic Liver Disease Patients Attending a Hospital in Kumaon Region. Journal of Family Medicine and Primary Care. 2022 Aug; 11(8): 4479-82. doi: 10.4103/jfmpc.jfmpc_404_22. DOI: https://doi.org/10.4103/jfmpc.jfmpc_404_22

Dellatore P, Cheung M, Mahpour NY, Tawadros A, Rustgi VK. Clinical Manifestations of Hepatic Encephalopathy. Clinics in Liver Disease. 2020 May; 24(2): 189-96. doi: 10.1016/j.cld.2020.01.010. DOI: https://doi.org/10.1016/j.cld.2020.01.010

Sharma K, Akre S, Chakole S, Wanjari MB, Wanjari M. Hepatic Encephalopathy and Treatment Modalities: A Review Article. Cureus. 2022 Aug; 14(8). doi: 10.7759/cureus.28016. DOI: https://doi.org/10.7759/cureus.28016

Sen BK, Pan K, Chakravarty A. Hepatic Encephalopathy: Current Thoughts on Pathophysiology and Management. Current Neurology and Neuroscience Reports. 2025 Dec; 25(1): 28. doi: 10.1007/s11910-025-01415-9. DOI: https://doi.org/10.1007/s11910-025-01415-9

Pathak R, Lamsal M, Bhusal M. Efficacy of Lactulose and Polyethylene Glycol in the Treatment of Hepatic Encephalopathy. Journal of Nepal Health Research Council. 2025 Jun; 23(01): 132-7. doi: 10.33314/jnhrc.v23i01.5442. DOI: https://doi.org/10.33314/jnhrc.v23i01.5442

Tan D, Chan KE, Wong ZY, Ng CH, Xiao J, Lim WH et al. Global Epidemiology of Cirrhosis: Changing Etiological Basis and Comparable Burden of Nonalcoholic Steatohepatitis Between Males and Females. Digestive Diseases. 2023 Dec; 41(6): 900-12. doi: 10.1159/000533946. DOI: https://doi.org/10.1159/000533946

Liu YB and Chen MK. Epidemiology of Liver Cirrhosis and Associated Complications: Current Knowledge and Future Directions. World Journal of Gastroenterology. 2022 Nov; 28(41): 5910. doi: 10.3748/wjg.v28.i41.5910. DOI: https://doi.org/10.3748/wjg.v28.i41.5910

Rashid M and Ismail H. HCV Extinction Analysis in District Gujrat, Pakistan by Using SARIMA And Linear Regression Models. Medicine. 2021 Dec; 100(49): e28193. doi: 10.1097/MD.0000000000028193. DOI: https://doi.org/10.1097/MD.0000000000028193

Gonzalez-Chagolla A, Olivas-Martinez A, Ruiz-Manriquez J, Servín-Rojas M, Kauffman-Ortega E, Chávez-García LC et al. Cirrhosis Etiology Trends in Developing Countries: Transition from Infectious to Metabolic Conditions. Report from a Multicentric Cohort in Central Mexico. The Lancet Regional Health–Americas. 2022 Mar; 7. doi: 10.1016/j.lana.2021.100151. DOI: https://doi.org/10.1016/j.lana.2021.100151

Zhang Y, Luo M, Ming Y. Global Burden of Cirrhosis and Other Chronic Liver Diseases Caused by Specific Etiologies from 1990 to 2021. BioMed Central Gastroenterology. 2025 Sep; 25(1): 641. doi: 10.1186/s12876-025-04264-5. DOI: https://doi.org/10.1186/s12876-025-04264-5

Fahad D, Haider S, Tabassum S, Khalid F, Mushtaque S, Ali A. Prognostic Significance of Hypokalemia on Length of Hospital Stay in Patients with Hepatic Encephalopathy. Pakistan Journal of Medical Research. 2022 Oct; 61(3): 130-3.

Ullah H, Shabana H, Rady MA, Abdelsameea E, Youssef MI, Helmy HA et al. Hypokalemia as a Responsible Factor Related with the Severity of Hepatic Encephalopathy: A Wide Multination Cross-Sectional Study. Annals of Medicine and Surgery. 2023 Jun; 85(6): 2427-31. doi: 10.1097/MS9.0000000000000470. DOI: https://doi.org/10.1097/MS9.0000000000000470

Khattak SY, Ahmad N, Khattak M, Mahmood B, Quddos A, Khan MA. Frequency of Electrolytes Abnormalities in Cirrhotic Patients Presenting with Hepatic Encephalopathy. Indus Journal of Bioscience Research. 2025 Jun; 3(6): 449-53. doi: 10.70749/ijbr.v3i6.1700. DOI: https://doi.org/10.70749/ijbr.v3i6.1700

Hassan T, Siddiqui UA, Ullah MS, Rana SQ, Khan MZ. Frequency of Hyponatremia among Patients with Hepatic Encephalopathy and Severity of Liver Disease. Journal of Medical and Health Sciences Review. 2024; 1(4). doi: 10.65035/r0vc5w65. DOI: https://doi.org/10.65035/r0vc5w65

Refardt J. Special Considerations of Hyponatremia in the Elderly Patient. Best Practice and Research Clinical Endocrinology and Metabolism. 2025 Sep: 102040. doi: 10.1016/j.beem.2025.102040. DOI: https://doi.org/10.1016/j.beem.2025.102040