Electrolyte Disturbances in Hepatic Encephalopathy in Intensive Care Unit

Abstract

Egypt has the highest prevalence of antibodies to hepatitis C virus (HCV) in the world, estimated nationally at 14.7%. The number of Egyptians estimated to be chronically infected was 9.8%. Cirrhosis develops in approximately 10% to 15% of individuals with chronic HCV infection. It is thought that most patients with cirrhosis will develop some degree of hepatic encephalopathy at some point during the course of the disease. In patients with active hepatic encephalopathy, reversible factors should be sought and managed; one of this is electrolyte imbalance. Disturbances in fluid and electrolytes are among the most common clinical problems encountered in the intensive care unit (ICU). Recent studies have reported that fluid and electrolyte imbalances are associated with increased morbidity and mortality among critically ill patients. A number of factors contribute to electrolyte disturbances in hepatic encephalopathy: impaired gluconeogenesis reduces the metabolism of lactic acid and leads to metabolic acidosis, abnormalities in the efficiency of the urea cycle can cause a reduction in bicarbonate use, and a reduction in protein synthesis and primarily albumin in the setting of hepatic encephalopathy all contribute to changes in acid-base balance.