Acid-base disorders in liver disease

Abstract

Alongside the kidneys and lungs, the liver has been recognised as an important regulator of acid-base homeostasis. While respiratory alkalosis is the most common acid-base disorder in chronic liver disease, various complex metabolic acid-base disorders may occur with liver dysfunction. While the standard variables of acid-base equilibrium, such as pH and overall base excess, often fail to unmask the underlying cause of acid-base disorders, the physical-chemical acid-base model provides a more in-depth pathophysiological assessment for clinical judgement of acid-base disorders, in patients with liver diseases. Patients with stable chronic liver disease have several offsetting acidifying and alkalinising metabolic acid-base disorders. Hypoalbuminaemic alkalosis is counteracted by hyperchloraemic and dilutional acidosis, resulting in a normal overall base excess. When patients with liver cirrhosis become critically ill (e.g., because of sepsis or bleeding), this fragile equilibrium often tilts towards metabolic acidosis, which is attributed to lactic acidosis and acidosis due to a rise in unmeasured anions. Interestingly, even though patients with acute liver failure show significantly elevated lactate levels, often, no overt acid-base disorder can be found because of the offsetting hypoalbuminaemic alkalosis. In conclusion, patients with liver diseases may have multiple co-existing metabolic acid-base abnormalities. Thus, knowledge of the pathophysiological and diagnostic concepts of acid-base disturbances in patients with liver disease is critical for therapeutic decision making.

Lactate Improves Prediction of Short‐Term Mortality in Critically Ill Patients With Cirrhosis

“…Traditionally, lactate has been deemed as a marker for tissue hypoxia, as lactate is overproduced and underutilized under these conditions due to impaired mitochondrial oxidation . Yet, the liver is responsible for up to 70% of whole‐body lactate clearance . Accordingly, especially acute hepatic impairment is associated with increased lactate levels .…”

“…(38) Yet, the liver is responsible for up to 70% of whole-body lactate clearance. (24,39) Accordingly, especially acute hepatic impairment is associated with increased lactate levels. (40) Additionally, in patients with fulminant hepatic failure and in ICU patients with cirrhosis, increased lactate was associated with poor outcome.…”

Treatment with metformin is associated with a prolonged survival in patients with hepatocellular carcinoma

“…Not surprisingly, these patients had a better hepatic function compared to diabetic patients not treated with metformin. The low number of HCC patients receiving metformin can be explained by the fact that metformin use was thought to be associated with an increased incidence of lactic acidosis in patients with impaired liver function . However, a recent study in patients with mainly compensated cirrhosis showed that metformin treatment was not only safe but also improved survival in patients with diabetes and non‐alcoholic steatohepatitis (NASH)‐associated cirrhosis …”

“…The low number of HCC patients receiving metformin can be explained by the fact that metformin use was thought to be associated with an increased incidence of lactic acidosis in patients with impaired liver function. 38 However, a recent study in patients with mainly compensated cirrhosis showed that metformin treatment was not only safe but also Additionally, there is increasing evidence that treatment with metformin decreases the risk of various cancers including HCC. A pivotal, population-based cohort study including 10 309 patients with T2DM observed a significantly decreased cancer-related mortality for metformin compared to sulphonylurea and insulin.…”

Comparatyive determination of proteins, nitrogen-containing compounds and lipids content in blood plasma and ascitic fluid in patients with liver cirrhosis

“…Отже, це є наслідком порушення білок-синтетичної функції печінки. Отримані дані збігаються з результатами клінічних досліджень обстежень, які додатково до печінкової дисфункції виявили порушення кислот-но-лужної рівноваги у хворих з ЦП [22]. Обмаль да-них наявна в літературі стосовно можливостей реви-користання АР при лікуванні ЦП -йдеться лише про ефективність реінфузії концентрата АР у пацієнтів з портальною гіпертензією [23].…”