Objective: Study conducted to know the prevalence of hyponatremia in cirrhosis and to evaluate the association between hyponatremia and complications in cirrhosis and its prognostic value.

Methods: Patients were selected based on clinical examination, biochemical tests and ultrasound abdomen. All the patients were examined at the time of admission in the hospital and their serum sodium levels were checked and the patients were followed during their stay in the hospital. The severity of cirrhosis was assessed according to Child-Pugh score. MELD score and MELD-Na score were also calculated at the time of admission.

Results: Study done on 100 cirrhotic patients, most common etiology for cirrhosis in this study was alcohol.  53% had hyponatremia(<136meq/l). Complications of cirrhosis were more in hyponatremia patients. Among the complications portal hypertension (57%), hepatic encephalopathy(89.28%), hepatorenal syndrome (42.8%) among hyponatremia cirrhotic patients are statistically significant(p<0.05). child pughturcot score, MELD, MELD-Na score are also high in hyponatremia. Mortality also seen more in severe hyponatremia.

Conclusion: Dilutional hyponatremia is frequent in cirrhotic patients and associated with severe complications of liver cirrhosis like hepatic encephalopathy, hepatorenal syndrome. Hyponatremia is also associated with high morbidity and mortality in cirrhotic patients.

Keywords: Cirrhosis, Hyponatremia ,Child Pugh Turcot score, MELD,MELD-Na,

1. Gines p, Bernadi M, Berl T, Bichet D.G, Hamon G, Jimenez W, Liard J.F, Martin P.Y, Schrier R.W, Hyponatremia in cirrhosis: from pathogenesis to treatment; 199828:851-864;doi: 10.1002/hep.510280337
2. Angeli P, Wong F, Watson H, Gines P, CAPPS Investigators, hyponatremia in cirrhosis: results of population survey. 2006;44:1535–1542. doi:10.1002/hep.2141
3. Boronni G., Maggi A.,Sangiovanni. A., Cazzaniga, M, Salerno F. Clinical relevance of hyponatremia for the hospital outcome of cirrhotic patients. Digestive and Liver Disease. 2000; 32: 605-610
4. Kim JH., Lee JS., Lee SH et al, The association between serum sodium and complication of the liver cirrhosis. Korean journal of Internal Medicine2009;24(2):106-112.doi:10.3904/kjim.2009.24.2.106.
5. Shaikh S, Mal G, Khaled S, Baloch GH, Akbar Y, Frequency of Hyponatremia and its influence on liver cirrhosis related complications. JPMA. 2010;60:116.
6. Moini M, Hoseini-Asl MK, Taghavi SA, Sagheb MM, Nikeghbalian S, Salahi H, Bahador A, Motzedian M, Jafari P, Malek-Hosseini SA. Hyponatremia a valuable predictor of early mortality in patients with cirrhosis listed for liver transplantation. Clin Transplant 2011:25:638-645.
7. Heuman DM, Abou-Assi SG, Habib A, Williams LM, Stravitz RT, Sanyal AJ, Fisher RA, Mihas AA. Persistent ascites and low serum sodium identify patients with cirrhosis and low MELD scores who are at risk for early death. Heptology 2004;40: 802-810 (PMID:15382176DOI:10.1002/hep.20405)
8. Arroyo V, Jimenez W: complication of cirrhosis and circulatory dysfunction, light shadows in an important clinical problem. J Heptalogy. 2000;32(sippl 1):157
9. Child, C.G.& Turcotte, J.G>Surgery and portal hypertension. In; C.G. Child editor. The Liver and Portal Hypertension. Philadelphia: Saunders;19664:50-64 .
10. Kumar Sumit, Berl Thomas. Sodium. The Lancet. 1998; 352:220.
11. Ellis SJ. Sever Hyponatremia: Complications and treatment. QJM. 1995;88:905.

D.Dinesh Kumar Reddy

Resident, Rangaraya Medical College, Kakinada, Andhrapradesh, India