الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Egypt has the highest prevalence of antibodies to hepatitis C virus (HCV) in the world, estimated nationally at 14.7%. The number of Egyptians estimated to be chronically infected was 9.8%. Cirrhosis develops in approximately 10% to 15% of individuals with chronic HCV infection.
It is thought that most patients with cirrhosis will develop some degree of hepatic encephalopathy at some point during the course of the disease.
In patients with active hepatic encephalopathy, reversible factors should be sought and managed; one of this is electrolyte imbalance.
Disturbances in fluid and electrolytes are among the most common clinical problems encountered in the intensive care unit (ICU). Recent studies have reported that fluid and electrolyte imbalances are associated with increased morbidity and mortality among critically ill patients.
A number of factors contribute to electrolyte disturbances in hepatic encephalopathy: impaired gluconeogenesis reduces the metabolism of lactic acid and leads to metabolic acidosis, abnormalities in the efficiency of the urea cycle can cause a reduction in bicarbonate use, and a reduction in protein synthesis and primarily albumin in the setting of hepatic encephalopathy all contribute to changes in acid-base balance.
Development of hyponatremia in critically ill patients is associated with disturbances in the renal mechanism of urinary dilution. Removal of nonosmotic stimuli for vasopressin secretion, judicious use of hypertonic saline, and close monitoring of plasma and urine electrolytes are essential components of therapy.
Hypernatremia is associated with cellular dehydration and central nervous system damage. Water deficit should be corrected with hypotonic fluid, and ongoing water loss should be taken into account. Deficiencies such as hypocalcemia, hypomagnesemia and hypophosphatemia should be identified and corrected, since they are associated with increased adverse events among critically ill patients.
Electrolyte abnormalities in critically ill patients can lead to fatal consequences. More caution to electrolyte disturbances should be exercised in intensive care because it is often impossible to adequately assess symptoms and signs of critically ill patients. To provide optimal management, clinicians should be knowledgeable about fluid and electrolyte homeostasis and the underlying pathophysiology of the respective disorders. In addition, intensivists should pay attention to the administered fluid and medications potentially associated with fluid and electrolyte disturbances.