title: Arterial and mixed venous acid-base status in patients with cirrhosis. Influence of liver failure.
abstract: Although it has been established that liver failure is associated with arterial hypocapnia and alkalaemia (i.e., respiratory alkalosis), the influence of liver failure on mixed venous acid-base status has not yet been studied. Thus, arterial and mixed venous acid-base status were simultaneously measured in controls and in a large series of patients with cirrhosis. Grade B patients (n = 28) or Grade C patients (n = 21) had significantly lower arterial and mixed venous carbon dioxide tensions than controls (n = 29). Grade B or Grade C patients also had significantly higher arterial, mixed venous pH, and lower mixed venous bicarbonate concentrations than controls. Among Grade A patients (n = 27), those with the lowest Pugh's score (i.e., equal to five) had significantly lower mixed venous carbon dioxide tension than controls. The other arterial and mixed venous acid-base values did not differ significantly between Grade A patients with the lowest Pugh's score and controls. Grade A patients with a Pugh's score equal to six and Grade B patients had similar acid-base disorders. No significant differences were found between groups concerning the anion gap and plasma chloride concentrations. In conclusion, this study shows that in Grade B or C patients, respiratory alkalosis was responsible for mixed venous hypocapnia, alkalaemia and hypobicarbonataemia. In addition, in Grade A patients with the lowest Pugh's score (equal to five), analysis of arterial and mixed venous blood revealed that mixed venous hypocapnia was the sole anomaly of the acid-base status. This last finding suggests that mixed venous hypocapnia might be an early event preceding the onset of arterial hypocapnia.
authors.affiliation: Service de Réanimation et de Médecine d'Urgence, Hôpital Emile-Roux, Eaubonne, France.
authors.forename: R
authors.initials: R
authors.lastname: Moreau
authors.forename: A
authors.initials: A
authors.lastname: Hadengue
authors.forename: T
authors.initials: T
authors.lastname: Soupison
authors.forename: M F
authors.initials: MF
authors.lastname: Mamzer
authors.forename: P
authors.initials: P
authors.lastname: Kirstetter
authors.forename: J L
authors.initials: JL
authors.lastname: Saraux
authors.forename: M
authors.initials: M
authors.lastname: Assous
authors.forename: J
authors.initials: J
authors.lastname: Roche-Sicot
authors.forename: C
authors.initials: C
authors.lastname: Sicot
mesh_terms: D000472:Alkalosis, Respiratory / Q000209:etiology; D001639:Bicarbonates / Q000097:blood; D001784:Blood Gas Analysis; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D016857:Hypocapnia / Q000209:etiology*; D008103:Liver Cirrhosis / Q000097:blood* / Q000150:complications; D017093:Liver Failure / Q000097:blood* / Q000150:complications; D008297:Male; D008875:Middle Aged
chemical_list: D001639:Bicarbonates