A clinical study of dyselectrolytemia in patients with cirrhosis and its correlation with severity of disease and development of complications

Background and Aim: Electrolyte disturbances are commonly observed in patients with cirrhosis of liver particularly in the advanced stages. This occurs as a result of mechanism inherent to the disease per se, side effects of the drugs as well as dietary restrictions. We aimed to study the prevalence of dyselectrolytemia in cirrhotic patients and its correlation with severity of disease and development complications like hepatic encephalopathy (HE) and hepatorenal syndrome (HRS). Methods: A prospective observational study was conducted in 150 patients with cirrhosis. Routine investigations including serum electrolytes (sodium, potassium and magnesium) were obtained at admission and compared with Child Pugh Score and MELD score. These were also followed for development of complications like HE and HRS. Results: Out of 150 cirrhotics (M=121; F=29), dyselectrolytemia was observed in 113 patients (75.30%). The mean sodium, potassium and magnesium level in our study was 128.40 ±2.50 meq/l, 3.29 ±0.48 meq/l and 1.55 ±0.28 meq/l. The most common abnormality was hyponatremia (92.03%) followed by hypokalemia (72.5%) and hypomagnesaemia (70.79%). Compared to Child- Pugh class A (20%), dyselectrolytemia was considerably greater in class B (76.1%) and C (90.2%) (P-value=0.01). Similarly, patients with MELD score > 21 had statistically significant (p=0.04) electrolyte disturbance (92.3%) than those with score < 21. Out of 56 patients who developed HRS (37.3%), dyselectrolytemia was seen in 96.4% (p=<0.05). Hyponatremia (96.4%) was the most common followed by hypokalemia (48.2%) and hypomagnesaemia (42.8%). 36 patients in our study developed HE (72.2%), out of which 26 had dyselectrolytemia (p<0.05%) and the most common abnormality was hypomagnesaemia (72.2%) followed by hypokalemia (66.67%). Conclusions: Dyselectrolytemia is highly prevalent in cirrhotic patients. Their values may reflect the level of liver dysfunction as evidenced by their strong correlation with disease severity scores such as Child-Pugh and MELD score and association with complications like HE and HRS.