What electrolyte disturbance can worsen hepatic encephalopathy?

• A. Hyperkalemia
• B. Hypercalcemia
• C. Hyponatremia
• D. Hypomagnesemia

Answer: (C)

The key idea is how electrolyte balance affects brain function in liver failure. Low sodium lowers the serum osmolality, so water shifts from outside to inside brain cells, causing cerebral edema. In hepatic encephalopathy, the liver can’t detoxify ammonia effectively, leading to ammonia buildup inside the brain and astrocyte swelling. When hyponatremia is present, this osmotic imbalance worsens brain edema and neuronal dysfunction, making confusion, lethargy, and even coma more likely.

Cirrhosis often leads to hypervolemic hyponatremia due to increased antidiuretic hormone and impaired water excretion, so sodium disturbances commonly aggravate hepatic encephalopathy. Other electrolyte disturbances might cause neurologic symptoms, but they don’t produce the same direct osmotic brain swelling that hyponatremia does in the context of liver failure.

So, hyponatremia is the electrolyte disturbance that most strongly worsens hepatic encephalopathy, because it exacerbates cerebral edema while ammonia-related toxicity is already impairing brain function.