Hypernatremia in Decompensated Cirrhosis—Is Lactulose Boon or Bane?

Background: Hyponatremia is common in cirrhosis and is associated with high mortality. In contrast, hypernatremia is less frequent and is typically caused by hypotonic fluid losses due to osmotic diuresis, increased insensible water losses, and reduced water intake, often associated with encephalopathy. Lactulose, commonly used for the management of hepatic encephalopathy (HE), sometimes paradoxically worsens the encephalopathy due to the development of dehydration and hypernatremia. Prompt identification of the cause of hypernatremia and slow correction of serum sodium is associated with improved short-term survival. Case Presentation: We report a case of acute on chronic liver failure with HE, who developed hypernatremia during hospital stay due to lactulose-induced diarrhoea that worsened his sensorium further. After adjusting the dose of lactulose and correcting hypernatremia, his encephalopathy improved, and he was subsequently discharged. Conclusion: Lactulose may cause hypernatremia, especially in cirrhosis patients with hepatic encephalopathy. Early identification of hypernatremia, along with its cause and slow correction of sodium, is associated with improved short-term survival in decompensated cirrhosis.