electrolyte in hepatic encephelopathy

 Q: Which electrolyte abnormality plays a role in the exacerbation of hepatic encephalopathy? (select one)

A) Hypokalemia

B) Hyponatremia

Answer: A

The presence of hypokalemia makes hepatic encephalopathy worse and should be corrected. Hypokalemia increases renal tubular production of ammonia. This ammonia enters back not only into the tubular lumen but also into the peritubular capillary. This process gets further exacerbated as these patients may also have concurrent metabolic alkalosis, which enhances ammonia's crossing of the blood-brain barrier. 

#hepatology

References:

1. Gabduzda GJ, Hall PW 3rd. Relation of potassium depletion to renal ammonium metabolism and hepatic coma. Medicine (Baltimore) 1966; 45:481. 

2. COOKE RE, SEGAR WE, CHEEK DB, et al. The extrarenal correction of alkalosis associated with potassium deficiency. J Clin Invest 1952; 31:798. 

3.  Artz SA, Paes IC, Faloon WW. Hypokalemia-induced hepatic coma in cirrhosis. Occurrence despite neomycin therapy. Gastroenterology 1966; 51:1046.