title: The acidifying effect of lactate is neutralized by the alkalinizing effect of hypoalbuminemia in non-paracetamol-induced acute liver failure.
abstract: OBJECTIVE
  Hyperlactatemia with unexplained absence of metabolic acidosis is observed in acute liver failure. In chronic liver disease offsetting metabolic acid-base disorders could be revealed by means of physical-chemical acid-base analysis. The purpose of this study was to determine whether the acidifying effect of lactate is neutralized by the alkalinizing effect of hypoalbuminemia in acute liver failure.
  
  
  METHODS
  Serial arterial blood samples of 46 consecutive patients with non-paracetamol-induced acute liver failure were studied after admission to a medical ICU in a prospective investigation and compared to healthy controls. Acid-base state was assessed by quantitative physical-chemical analysis.
  
  
  RESULTS
  Lactate was increased and albumin was decreased in patients with acute liver failure compared to healthy controls resulting in normal net metabolic acid-base state. The alkalinizing effect of hypoalbuminemia was neutralized by the acidifying effect of elevated lactate. This observation was confirmed in serial analysis during 5 days after admission.
  
  
  CONCLUSIONS
  The acidifying effect of lactate is neutralized by the alkalinizing effect of hypoalbuminemia in non-paracetamol-induced acute liver failure. The absence of apparent metabolic acidosis in the presence of elevated lactate can be explained by means of the physical-chemical acid-base model.
authors.affiliation: Klinik fuer Innere Medizin IV, ICU 13H1, Medical University of Vienna, Allgemeines Krankenhaus, Waehringerguertel 18-20, A - 1090 Vienna, Austria. georg-christian.funk@meduniwien.ac.at
authors.forename: Georg-Christian
authors.initials: GC
authors.lastname: Funk
authors.forename: Daniel
authors.initials: D
authors.lastname: Doberer
authors.forename: Valentin
authors.initials: V
authors.lastname: Fuhrmann
authors.forename: Ulrike
authors.initials: U
authors.lastname: Holzinger
authors.forename: Reinhard
authors.initials: R
authors.lastname: Kitzberger
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Kneidinger
authors.forename: Gregor
authors.initials: G
authors.lastname: Lindner
authors.forename: Bruno
authors.initials: B
authors.lastname: Schneeweiss
mesh_terms: D000082:Acetaminophen / Q000009:adverse effects; D000136:Acid-Base Equilibrium; D000138:Acidosis / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology; D000328:Adult; D000418:Albumins / Q000378:metabolism; D018712:Analgesics, Non-Narcotic / Q000009:adverse effects; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D034141:Hypoalbuminemia / Q000209:etiology* / Q000378:metabolism* / Q000503:physiopathology; D015994:Incidence; D007773:Lactates / Q000378:metabolism*; D017114:Liver Failure, Acute / Q000209:etiology* / Q000378:metabolism* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D000418:Albumins; D018712:Analgesics, Non-Narcotic; D007773:Lactates; D000082:Acetaminophen