title: Acid-base disturbance in patients with cirrhosis: relation to hemodynamic dysfunction.
abstract: OBJECTIVE
  Acid-base disturbances were investigated in patients with cirrhosis in relation to hemodynamic derangement to analyze the hyperventilatory effects and the metabolic compensation.
  
  
  METHODS
  A total of 66 patients with cirrhosis and 44 controls were investigated during a hemodynamic study.
  
  
  RESULTS
  Hyperventilatory hypocapnia was present in all patients with cirrhosis and progressed from Child class A to C (P<0.01). Arterial pH increased significantly from class A to C (P<0.001) and was correlated inversely to the mean arterial blood pressure (r=-0.30, P<0.02), systemic vascular resistance (r=-0.25, P<0.05), indocyanine green clearance (r=-0.37, P<0.005), and serum sodium (r=-0.38, P<0.002). Metabolic compensation was shown by a reduced standard base excess in all patients (P<0.001). Standard base excess contained elements related to changes in serum albumin, water dilution, and effects of unidentified ions (all P<0.001). A significant hepatic component in the acid-base disturbances could not be identified.
  
  
  CONCLUSIONS
  Hypocapnic alkalosis is related to disease severity and hyperdynamic systemic circulation in patients with cirrhosis. The metabolic compensation includes alterations in serum albumin and water retention that may result in a delicate acid-base balance in these patients.
authors.affiliation: aDepartment of Clinical Physiology and Nuclear Medicine bGastro Unit, Medical Division, Hvidovre Hospital, Faculty of Medical and Health Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Jens H
authors.initials: JH
authors.lastname: Henriksen
authors.forename: Flemming
authors.initials: F
authors.lastname: Bendtsen
authors.forename: Søren
authors.initials: S
authors.lastname: Møller
mesh_terms: D000136:Acid-Base Equilibrium; D000328:Adult; D000368:Aged; D000472:Alkalosis, Respiratory / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006863:Hydrogen-Ion Concentration; D006985:Hyperventilation / Q000209:etiology / Q000503:physiopathology; D016857:Hypocapnia / Q000209:etiology / Q000503:physiopathology; D053208:Kaplan-Meier Estimate; D008102:Liver Circulation; D008103:Liver Cirrhosis / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D011379:Prognosis; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis; D000075462:Serum Albumin, Human; D012720:Severity of Illness Index; D012964:Sodium / Q000097:blood; D013997:Time Factors
chemical_list: C422455:ALB protein, human; D015415:Biomarkers; D012709:Serum Albumin; D012964:Sodium; D000075462:Serum Albumin, Human