A prospective study of gastric mucosal ischaemia in paracetamol-induced acute liver failure.
OBJECTIVE
To evaluate the time course of changes in the gastric mucosal pH (pHi) and the gastric mucosal to arterial CO2 gap (CO2 gap) following paracetamol-induced acute liver failure and to relate these variables to the severity of illness.


METHODS
Clinical prospective study.


METHODS
A liver intensive care unit in a university teaching hospital.


METHODS
Twenty-three patients with paracetamol-induced acute liver failure.


METHODS
Gastric tonometer placement.


RESULTS
Daily assessment of pHi and CO2 gap, the systemic organ failure assessment (SOFA) score for up to 9 days post-paracetamol ingestion. Both pHi and CO2 gap were within the normal range on entry into the study. The CO2 gap showed increases from the normal range on days 5-7 post-ingestion (P<0.01) and increases from study entry on days 4, 7, and 8 post-ingestion (P< 0.01). The pHi showed decreases from the normal range on days 4, 6, 7 and 9 post-ingestion (P< 0.01) and decreases from study entry on days 4, 5, 7, and 9 post-ingestion (P<0.01). There was no correlation found between pHi, CO2 gap, and the SOFA score.


CONCLUSIONS
Paracetamol-induced acute liver failure is associated with increases in the CO2 gap and decreases in pHi between 4 to 9 days post-paracetamol ingestion. This may reflect changes in mesenteric blood flow related to hepatic regeneration. These changes may be in part responsible for some of the morbidity seen with this condition.
Rhodes
A
A
Institute of Liver Studies, King's College Hospital, London, UK. arhodes@dial.pipex.com
Gabe
S M
SM
Wendon
J A
JA
D000082:Acetaminophen / Q000009:adverse effects*; D000328:Adult; D000368:Aged; D018712:Analgesics, Non-Narcotic / Q000009:adverse effects*; D000704:Analysis of Variance; D002245:Carbon Dioxide / Q000097:blood; D005260:Female; D005753:Gastric Mucosa / Q000098:blood supply* / Q000503:physiopathology*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007511:Ischemia / Q000503:physiopathology*; D017114:Liver Failure, Acute / Q000139:chemically induced*; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000175:diagnosis / Q000503:physiopathology; D011446:Prospective Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric
D018712:Analgesics, Non-Narcotic; D002245:Carbon Dioxide; D000082:Acetaminophen