Hyponatremic and hepatic encephalopathies: similarities, differences and coexistence

Metab Brain Dis. 2010 Mar;25(1):73-80. doi: 10.1007/s11011-010-9172-3. Epub 2010 Mar 9.


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.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Astrocytes / metabolism
  • Astrocytes / pathology
  • Brain / metabolism*
  • Brain / physiopathology
  • Brain Diseases, Metabolic / diagnosis
  • Brain Diseases, Metabolic / etiology
  • Brain Diseases, Metabolic / physiopathology*
  • Brain Edema / etiology
  • Brain Edema / metabolism
  • Brain Edema / physiopathology*
  • Diagnosis, Differential
  • Hepatic Encephalopathy / diagnosis
  • Hepatic Encephalopathy / physiopathology*
  • Humans
  • Hyponatremia / complications
  • Hyponatremia / diagnosis
  • Hyponatremia / physiopathology*
  • Liver Failure, Acute / complications
  • Liver Failure, Acute / physiopathology
  • Water-Electrolyte Balance / physiology