Title: Study of Serial Serum Sodium Values in Decompensated Liver Disease Patients during the Phase of Hepatic Encephalopathy
Authors: Gurusamy Gurunamasivayam, Arunkumar Jayakumar, Santhi Thoppappatty Sengottaiyan, Palani Kannan
DOI: https://dx.doi.org/10.18535/jmscr/v5i12.17
Abstract
Background: Hepatic encephalopathy is a dreaded complication of chronic liver disease patients in the decompensated state, associated with high percentage of mortality. Decompensated liver disease is associated with lower serum sodium values than compensated liver disease, though grading of hepatic encephalopathy scales are available, they are clinical and subjective to variation in the clinicians examination.
Aim: This study was done in order to study the corroboration of serum sodium values with various grades of hepatic Encephalopathy and to see the utility of serial serum sodium values as prognostic indicator in the outcome of patients with decompensated liver disease with hepatic Encephalopathy.
Materials and Methods: Study design planned is a Descriptive, case control study. Cases were obtained from the intensive care unit of Govt. Kilpauk Medical college. Controls were enrolled from the outpatient department. The patients with h/o chronic liver disease presenting in decompensated state in Hepatic encephalopathy as per West Haven criteria will be included in the study Patients who are in Hepatic encephalopathy Stage 2-4 are taken. The patients who are in hepatic encephalopathy will be studied from the time of admission for duration of 2 weeks to assess whether they are improving or not. Serial monitoring of the blood parameters will be done tabulated and compared to assess the variation of serum sodium levels during the period of two weeks. At the end of two weeks the mean serum sodium values between those in Hepatic encephalopathy (Grade 2-4) and those in the controls with no or early Hepatic Encephalopathy will be compared.
Results: It is evident that there is an improvement in the mean Serum sodium values from Day 1 to Day 14 in the cases. There is also a shift in the clustering of cases with hepatic encephalopathy from higher grades (4-3) to lower grades (2 – 1) during the course of the study. When the cases and controls were compared there is a significant difference in the fluctuations of the serum sodium levels from day 1 to day 14 in the cases when compared to the control. In both the above statistical tools the probability value 0.05 is considered as significant level.
Conclusion: If not an absolute indicator and also with the lack of high end investigations serum sodium values may serve to be an easily accessible tool to assess the initial condition of patients with hepatic encephalopathy. In resource deficient settings and in physician assessment with conflicting status of the patient, serum sodium may help assess the response to treatment.
Keywords: Hepatic Encephalopathy, Decompensated Liver Disease, West Haven Criteria, Hyponatremia
