Serum Electrolytes: a simple predictive test for grading severity of overt hepatic encephalopathy.

Background: hepatic encephalopathy (HE) is challenging clinical situation. Non invasive bed side test is highly required for prediction of its grade severity. Aim of the work: is to evaluate serum electrolytes and trace elements as predictors of grade severity of overt HE. Patients and methods: 75 cirrhotic patients were divided into two Groups: Group A included 15 cirrhotic patients without HE, and Group B subdivided into Groups B1, B2, B3 and B4, each included 15 patients with grade I, II, III and IV HE respectively. Measurements of serum sodium, potassium, zinc and magnesium along with calculation of Child and MELD scores were done. Results: there was statistically significant difference between Group A and the four subgroups of HE as regard Na+ and Zn+ and between Group A and Groups B2,3,4 as regard K+, Mg+. There was significant correlation between serum electrolytes and Child score in higher grades of encephalopathy. Cut off values of serum Na+?131mmol/l , K+?3.6mmol/l, Zn+? 59µg/dl and Mg+ ?1.7mg/dl were the best for prediction of grade I HE by Roc curve, while levels of Na+?122mmol/l, K+?3.1mmol/l, Zn+?49 µg/dl, Mg+?1.6mg/dl were the best for prediction of grade IV HE. Conclusion: lower levels of serum electrolytes and trace elements are found in higher grades of hepatic encephalopathy. They correlate with the Child score. They can be used as simple, non invasive bed side test for prediction of grade severity of overt hepatic encephalopathy.