Background: ‏Hepatic encephalopathy is a frequent and serious complication of both chronic liver disease and acute liver failure that lead to impaired quality of life, increased morbidity and mortality. Hyponatremia, a cause of brain dysfunction and risk factor for hepatic encephalopathy, is frequent in patients with advanced cirrhosis and ascites. The interdependence of liver failure and hyponatremia makes it difficult to separate the effects of each on cognitive function.

Aim: To study the correlation between serum sodium levels and serum ammonia levels in relation with hepatic encephalopathy in patients with liver cirrhosis and to evaluate the association between hyponatremia and hyperammonia with mortality.

Patients and methods: This case control prospective cohort study was conducted at Internal Medicine Department, Zagazig University Hospitals. Subjects were divided into group (A) (control group): apparent healthy age and sex matched participants, group (B) (case group): cirrhotic patients who were subdivided into: group (B1) cirrhotic patients with class A child pugh, group (B2): cirrhotic patients with class B child pugh and group (B3): cirrhotic patients with class C child pugh. Routine laboratory investigations and sodium were measured.

Results: On multiple regression analysis, AFP, MELD score, ammonia, ALT, hyperammonia and hyponatremia were significant predictors of mortality in cirrhotic patients.

Conclusion: Hyponatremia and hyperammonemia is a prognostic indicator for hepatic encephalopathy in Cirrhotic Patients and can be used as a predictor to mortality.