[Serum sodium as prognostic factor in hepatic coma]

Among 17,628 discharges from the Department of Medical Gastroenterology, Odense University Hospital during the period 1 April 1973 to 31 May 1992, 66 (3.74/1000) discharges in 55 patients were found with the EDP-code 573.00 coma hepaticum. The case records of these patients were examined, and the lowest serum sodium values were compared between the patients who survived hepatic coma and those who did not and were correlated to the total duration of hospitalisation and the serum creatinine value measured at the same time as the lowest serum sodium value. The case records of 54 patients could be found, but in one case there was no serum sodium value; thus, the final material included 53 patients with 53 cases of hepatic coma and 53 lowest serum sodium values, 25 from patients who survived hepatic coma and 28 from patients who died. 15/28 (53.6%) lowest serum sodium values during fatal coma admissions were 119 mmol/l or below, whereas 6/25 values during non-fatal coma admissions were 119 mmol/l or below (p < 0.05). There was a negative correlation between the lowest measured serum sodium value and the total duration of hospitalisation (p < 0.00004). Exponential regression analysis showed negative correlation between serum creatinine and serum sodium (p = 0.0144).

The correlations mentioned above may raise the question whether serum sodium should be kept at 120 mmol/l or above in patients suffering from hepatic coma. It is not predictable whether such a measure will prevent or attenuate cerebral symptoms and improve survival rate.