Hyponatremic and Hepatic Encephalopathies: Similarities, Differences and Coexistence

Overview

Journal Metab Brain Dis

Publisher Springer

Specialties Endocrinology
Neurology

Date 2010 Mar 11

PMID 20217202

Citations 26

Authors

Juan Cordoba

Rita Garcia-Martinez

Macarena Simon-Talero

Affiliations

Soon will be listed here.

Abstract

Hyponatremic and hepatic encephalopathy are common causes of metabolic encephalopathy that may coexist in patients with cirrhosis. The clinical picture is common to any metabolic encephalopathy and is characterized by a confusional syndrome that may evolve into coma. Chronic mild or minimal manifestations can be seen in both, but motor symptoms are more common in hepatic encephalopathy. Recent advances show that in addition to clinical manifestations both encephalopathies share some pathogenetic mechanisms. Dysfunction of astrocytes, osmotic changes in the brain and brain edema are present in both situations. Recognition of these abnormalities is important to plan therapy. New drugs that affect brain hydration may be useful for both encephalopathies.

Citing Articles

Reversibility of structural and functional alterations of hepatic encephalopathy.

Pflugrad H, Hennemann A Metab Brain Dis. 2024; 40(1):59.

PMID: 39661215 DOI: 10.1007/s11011-024-01497-3.

Liver fibrosis score is associated with the mortality of traumatic brain injury patients.

Wang R, Cai L, Liu Y, Zhang J, He M, Xu J Neurosurg Rev. 2023; 46(1):201.

PMID: 37581745 DOI: 10.1007/s10143-023-02095-0.

Acute hearing and visual loss caused by thiamine deficiency.

Xu J, Li F, Xue Y BMC Neurol. 2023; 23(1):285.

PMID: 37525097 PMC: 10388443. DOI: 10.1186/s12883-023-03337-w.

Lipopolysaccharide From Increases Glutamate-Induced Disturbances of Calcium Homeostasis, the Functional State of Mitochondria, and the Death of Cultured Cortical Neurons.

Bakaeva Z, Lizunova N, Tarzhanov I, Boyarkin D, Petrichuk S, Pinelis V Front Mol Neurosci. 2022; 14:811171.

PMID: 35069113 PMC: 8767065. DOI: 10.3389/fnmol.2021.811171.

Acute Acquired Metabolic Encephalopathy Based on Diffusion MRI.

Jeon S, Choi S, Kim H, Yu I Korean J Radiol. 2021; 22(12):2034-2051.

PMID: 34564957 PMC: 8628163. DOI: 10.3348/kjr.2019.0303.

References

Cordoba J, Gottstein J, Blei A . Chronic hyponatremia exacerbates ammonia-induced brain edema in rats after portacaval anastomosis. J Hepatol. 1998; 29(4):589-94. DOI: 10.1016/s0168-8278(98)80154-2. View

Donovan J, Schafer D, Shaw Jr B, Sorrell M . Cerebral oedema and increased intracranial pressure in chronic liver disease. Lancet. 1998; 351(9104):719-21. DOI: 10.1016/S0140-6736(97)07373-X. View

Sharma B, Sharma P, Agrawal A, Sarin S . Secondary prophylaxis of hepatic encephalopathy: an open-label randomized controlled trial of lactulose versus placebo. Gastroenterology. 2009; 137(3):885-91, 891.e1. DOI: 10.1053/j.gastro.2009.05.056. View

Cordoba J, Raguer N, Flavia M, Vargas V, Jacas C, Alonso J . T2 hyperintensity along the cortico-spinal tract in cirrhosis relates to functional abnormalities. Hepatology. 2003; 38(4):1026-33. DOI: 10.1053/jhep.2003.50406. View

Rama Rao K, Norenberg M . Aquaporin-4 in hepatic encephalopathy. Metab Brain Dis. 2007; 22(3-4):265-75. DOI: 10.1007/s11011-007-9063-4. View

Jalan R, Dabos K, Redhead D, Lee A, Hayes P . Elevation of intracranial pressure following transjugular intrahepatic portosystemic stent-shunt for variceal haemorrhage. J Hepatol. 1998; 27(5):928-33. DOI: 10.1016/s0168-8278(97)80333-9. View

Arieff A, Guisado R . Effects on the central nervous system of hypernatremic and hyponatremic states. Kidney Int. 1976; 10(1):104-16. DOI: 10.1038/ki.1976.82. View

Guevara M, Baccaro M, Torre A, Gomez-Anson B, Rios J, Torres F . Hyponatremia is a risk factor of hepatic encephalopathy in patients with cirrhosis: a prospective study with time-dependent analysis. Am J Gastroenterol. 2009; 104(6):1382-9. DOI: 10.1038/ajg.2009.293. View

Ferenci P, Lockwood A, Mullen K, Tarter R, Weissenborn K, Blei A . Hepatic encephalopathy--definition, nomenclature, diagnosis, and quantification: final report of the working party at the 11th World Congresses of Gastroenterology, Vienna, 1998. Hepatology. 2002; 35(3):716-21. DOI: 10.1053/jhep.2002.31250. View

10.

Inouye S . Delirium in older persons. N Engl J Med. 2006; 354(11):1157-65. DOI: 10.1056/NEJMra052321. View

11.

Gage P, QUASTEL D . Influence of sodium ions on transmitter release. Nature. 1965; 206(988):1047-8. DOI: 10.1038/2061047a0. View

12.

Arieff A, Llach F, Massry S . Neurological manifestations and morbidity of hyponatremia: correlation with brain water and electrolytes. Medicine (Baltimore). 1976; 55(2):121-9. DOI: 10.1097/00005792-197603000-00002. View

13.

Rovira A, Cordoba J, Raguer N, Alonso J . Magnetic resonance imaging measurement of brain edema in patients with liver disease: resolution after transplantation. Curr Opin Neurol. 2002; 15(6):731-7. DOI: 10.1097/01.wco.0000044771.39452.8d. View

14.

Shawcross D, Balata S, Olde Damink S, Hayes P, Wardlaw J, Marshall I . Low myo-inositol and high glutamine levels in brain are associated with neuropsychological deterioration after induced hyperammonemia. Am J Physiol Gastrointest Liver Physiol. 2004; 287(3):G503-9. DOI: 10.1152/ajpgi.00104.2004. View

15.

Cordoba J, Gottstein J, Blei A . Glutamine, myo-inositol, and organic brain osmolytes after portocaval anastomosis in the rat: implications for ammonia-induced brain edema. Hepatology. 1996; 24(4):919-23. DOI: 10.1002/hep.510240427. View

16.

Poordad F . Review article: the burden of hepatic encephalopathy. Aliment Pharmacol Ther. 2007; 25 Suppl 1:3-9. DOI: 10.1111/j.1746-6342.2006.03215.x. View

17.

Takahashi H, Koehler R, Brusilow S, Traystman R . Inhibition of brain glutamine accumulation prevents cerebral edema in hyperammonemic rats. Am J Physiol. 1991; 261(3 Pt 2):H825-9. DOI: 10.1152/ajpheart.1991.261.3.H825. View

18.

Norenberg M . Astrocytic-ammonia interactions in hepatic encephalopathy. Semin Liver Dis. 1996; 16(3):245-53. DOI: 10.1055/s-2007-1007237. View

19.

Brusilow S, Traystman R . Hepatic encephalopathy. N Engl J Med. 1986; 314(12):786-7. View

20.

Garcia Martinez R, Rovira A, Alonso J, Aymerich F, Huerga E, Jacas C . A long-term study of changes in the volume of brain ventricles and white matter lesions after successful liver transplantation. Transplantation. 2010; 89(5):589-94. DOI: 10.1097/TP.0b013e3181ca7bb3. View