In 24 cirrhotic patients at different stages of hepatic failure, factor VIII: C (F VIIl·C), factor VIΠR:AG (F VIIIR:AG), factor VIII AG/C ratio (F VIII AG/C), and serum fibrin-fibrinogen degradation products (FDP) were investigated. In 11 of the 24 patients, several instances of gastrointestinal bleeding due to esophageal varices rupture were documented and 5 patients died of unarrestable bleeding. In our study, we evaluated whether the cause of bleeding was the development of intravascular coagulation or the severity of hepatic failure. A statistically significant difference between F VIIl·C, F VIIIR:AG/C ratio, and serum FDP was found in bleeding in comparison with non-bleeding patients. An inverse correlation between the F VIII :C plasma level and serum FDP as well as a direct correlation between F VIII AG/C ratio and serum FDP in the group of bleeding patients were also found. These data seem to suggest a hypercoagulable state which was more significant in the 5 patients who died owing to bleeding. Furthermore, only 1 of these patients had severe hepatic failure. From this study it appears that, in cirrhotic patients, bleeding is related more to the appearance of disseminated intravascular coagulation, as a consequence of both hemodynamic and endothelial changes, than to the degree of hepatic failure itself.

The intracellular pH (pHi) of skeletal muscle, obtained by needle biopsy, was determined in 14 patients with chronic non-terminal renal acidosis and 6 normal subjects. Furthermore, the muscle composition in electrolytes and alkali-soluble protein nitrogen was analyzed. In patients with chronic renal acidosis the mean pHi value (6.88 ± 0.12) was not significantly different from that of the controls (6.92 ± 0.11). No correlation between intra- and extracellular pH values nor between pHi and plasma creatinine or cell sodium ion concentration was found. A significant direct linear relationship between pHi and potassium content in skeletal muscle was observed. These results suggest that potassium depletion is partly related to the increase in intracellular hydrogen ion concentration.

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