Does low sodium level worsen hepatic encephalopathy?

Question

Hi doctor,

I hope you are well. I am writing on behalf of my 58-year-old mother. She has end-stage liver disease related to long-term alcohol use. Earlier this year, she was hospitalized twice for overt hepatic encephalopathy. During the most recent episode, she experienced significant cognitive and physical impairment and was barely able to walk or speak clearly for nearly two weeks.

She was discharged on Xifaxan 550 mg twice daily and lactulose. Recently, however, we’ve noticed concerning early symptoms again, including hand tremors, increased forgetfulness, and reduced awareness. She accidentally burned herself on the stove yesterday because she did not notice the flame. Her most recent labs also show a sodium level of 126 mEq/L.

Her gastroenterologist is located quite far from us, and the earliest available appointment is in 10 days. We are concerned that this may represent the beginning of another episode of overt hepatic encephalopathy.

Would you advise any additional measures we can take at home in the meantime, or should we seek immediate evaluation in the emergency department?
How concerning is her low sodium level in the context of her encephalopathy?

Thank you very much for your guidance.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concern.

The symptoms you have reported currently create a dangerous situation that requires immediate medical attention instead of waiting for 10 days until your scheduled appointment.

Your mother shows early signs of neurological decline through her tremors, forgetfulness, and loss of awareness, which has resulted in a permanent burn injury because she needs observation for possible hepatic encephalopathy development.

The sodium level of 126 mEq/L represents a critical deficiency, especially because the patient has advanced liver disease. Hyponatremia causes severe confusion, which increases fall hazards and leads to additional neurological impairments and, in extreme situations, results in seizures and immediate medical deterioration. The presence of both hyponatremia and hepatic encephalopathy increases the chances of mental status deterioration. The combination of these two conditions needs hospital monitoring, controlled treatment, and some patients require intensive care unit treatment.

Home care does not allow for any extra medications to be started because her only treatment should begin with lactulose intake after she reaches alertness to take her medications. Do not force medications into her if she shows drowsiness or less responsiveness, or if she cannot take medications safely. The patient needs immediate transfer to an emergency medical facility.

The combination of early diagnosis and treatment will stop the condition from developing into a critical stage, which will decrease the need for intensive care unit treatment.

I hope this addresses your concern.

Please provide comments and let me know if you have any more questions.

I would be pleased to assist you further.

Thank you.