Patients with hepatic disease are prone to __________ under anesthesia.

• A. Hypoproteinemia
• B. Hypoglycemia
• C. Hyponatremia
• D. Hyperproteinemia

Answer: (A)

When the liver is diseased, its ability to synthesize proteins, especially albumin, is reduced. That lowers plasma protein levels, i.e., hypoproteinemia, which reduces oncotic pressure and promotes edema with fluid shifts. Under anesthesia this is important because many anesthetic drugs are protein-bound; with less albumin, a larger fraction remains unbound, increasing drug activity and the risk of hypotension or prolonged effects. While hypoglycemia or hyponatremia can occur in liver disease, the most direct and expected issue during anesthesia is hypoproteinemia.