Equilibrium of acidifying and alkalinizing metabolic acid-base disorders in cirrhosis.
OBJECTIVE
Conflicting results exist with regard to metabolic acid-base status in liver cirrhosis, when the classic concept of acid-base analysis is applied. The influence of the common disturbances of water, electrolytes and albumin on acid-base status in cirrhosis has not been studied. The aim of this study was to clarify acid-base status in cirrhotic patients by analyzing all parameters with possible impact on acid-base equilibrium.


METHODS
Fifty stable cirrhotic patients admitted to a university hospital. Arterial acid-base status was analyzed using the principles of physical chemistry and compared with 10 healthy controls.


RESULTS
Apart from mild hypoalbuminemic alkalosis, acid-base state was normal in Child-Pugh A cirrhosis. Respiratory alkalosis was the net acid-base disorder in Child-Pugh B and C cirrhosis with a normal overall metabolic acid-base state (Base excess-1.0 (-3.6 to 1.6) vs 1.1 (-0.2 to 1.1) mmol/l, P = 0.136, compared with healthy controls, median (interquartile range)). Absence of an apparent metabolic acid-base disorder was based on an equilibrium of hypoalbuminemic alkalosis and of dilutional acidosis and hyperchloremic acidosis.


CONCLUSIONS
A balance of offsetting acidifying and alkalinizing metabolic acid-base disorders leaves the net metabolic acid-base status unchanged in cirrhosis.
Funk
Georg-Christian
GC
Fourth Medical Department, Medical University of Vienna, Austria. georg-christian.funk@meduniwien.ac.at
Doberer
Daniel
D
Osterreicher
Christoph
C
Peck-Radosavljevic
Markus
M
Schmid
Monika
M
Schneeweiss
Bruno
B
D000137:Acid-Base Imbalance / Q000188:drug therapy / Q000209:etiology* / Q000378:metabolism*; D000138:Acidosis / Q000188:drug therapy / Q000209:etiology / Q000378:metabolism; D000368:Aged; D000471:Alkalosis / Q000188:drug therapy / Q000209:etiology / Q000378:metabolism; D004232:Diuretics / Q000627:therapeutic use; D004573:Electrolytes / Q000097:blood; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008103:Liver Cirrhosis / Q000150:complications* / Q000188:drug therapy / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D012709:Serum Albumin / Q000378:metabolism; D012720:Severity of Illness Index
D004232:Diuretics; D004573:Electrolytes; D012709:Serum Albumin