January-March 2018

Prevalence of hyponatremia and its significance among patients with liver cirrhosis

M.Kumar Raja1*, S.Moogaambiga2, V.Sundaravel3, Ani Thampi4, Shankar Radhakrishnan5*

1Assistant Professor, 3Professor, 4Post Graduate, Department Of Medicine, Govt.Mohan Kumaramangalam, Medical    College, Salem.

2Assistant Professor, Vinayaga Missions Kirubanantha Variyar Medical College, Salem.

5Associate Professor, Department Of Preventive Medicine, Vmkvmch, Salem.



BACKGROUND: Hyponatraemia in cirrhosis largely occurs in the setting of expanded extracellular fluid volume. The relationship between hyponatremia and severity of cirrhosis is evidenced by its close association with the occurrence of complications like hepatic encephalopathy, hepatorenal syndrome and spontaneous bacterial peritonitis. Serum sodium concentration is also included in the prognostic model for end-stage liver disease (MELD). AIM: To assess the prevalence of hyponatremia and to correlate hyponatraemia with the severity of liver disease among the patients with cirrhotic liver disease. METHODOLOGY: A cross sectional observational study was conducted among 100 consecutive patients with cirrhosis of liver admitted in our hospital during the period of June 2015 to May 2016. Patients were recruited for the study based on the diagnosis of cirrhosis which was confirmed by clinical, biochemical, and ultrasonographic findings and for few cases endoscopic findings of oesophageal varices was made. Based on the biochemical parameters the severity of cirrhosis was assessed according to Child-Pugh score. A total score from 5-6, 7-9 and 10-15 were classified as class A, B and C respectively. In our study chronic hyponatremia was defined as serum level of sodium < 130 meq/L. RESULTS: The serum sodium levels of the study subjects had shown that 48% of them had normal sodium levels and 21% had mild hyponatremia and the remaining 31% had severe hyponatremia. Based on the child pugh score of liver cirrhosis class B patients had the mean sodium levels of 133.5 meq/L whereas class C patients sodium levels were 124.8 meq/L and the difference was found to be statistically significant. The correlation between the mean MELD score and the serum sodium levels had shown a strong negative correlation between them. CONCLUSION: Our study had proven a strong association of hyponatremia among patients with liver cirrhosis. Further prospective studies are needed to determine the clinical significance of hyponatremia and identify its correlation with the incidence of possible complications.

Keywords: Hyponatremia, liver cirrhosis, MELD score.

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