Respiration and Circulation in Patients with Portal Cirrhosis of the Liver

Heinemann, H.

doi:10.1161/01.cir.22.1.154

Cited by 31 publications

(11 citation statements)

References 37 publications

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confidence: 77%

“…Albumin and bilirubin levels and prothrombin time were deHyperammonemia is common in cirrhotic patients; ammo-termined from venous blood obtained approximately 2 weeks before nia, however, has not been shown to correlate with minute this procedure. ventilation, 3 and ammonia infusions did not decrease P a CO 2 The estradiol and progesterone levels were measured by Immulite in volunteers. 7 In an interesting study, hypoalbuminemic pa-chemiluminescent enzyme immunoassays (Diagnostics Products tients with and without cirrhosis had a respiratory alkalosis Corporation, Los Angeles, CA).…”

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confidence: 91%

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The hyperventilation of cirrhosis: Progesterone and estradiol effects

Lustik

1997

Hepatology

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treat hypoventilation disorders. 12 Although plasma progesProgesterone and estradiol are metabolized in the terone is elevated in cirrhotic patients because of decreased liver and are elevated in patients with cirrhosis. Progeshepatic metabolism, progesterone has not been proved to terone stimulates ventilation by activating progesterone cause their hyperventilation. receptors in the central nervous system; estradiol mayWe propose estradiol as a contributing factor to respiratory facilitate progesterone's actions by increasing progesalkalosis, although this has not been examined in humans. terone receptors. This study evaluated whether progesEstradiol is metabolized by the liver into estriol, which has terone and estradiol contribute to the respiratory alkaminimal estrogen effects. Estradiol has no direct respiratory losis common in cirrhotic patients. Arterial blood gases stimulatory effect; 13 however, estradiol increases the number and progesterone and estradiol levels were obtained in of progesterone receptors in animals and may facilitate pro-50 patients with cirrhosis. Multiple linear regression regesterone's actions.14,15vealed a statistically significant correlation between This report examines the roles of hyperprogesteronemia P a CO 2 and progesterone and estradiol (r Å .54, P õ .05).and hyperestradiolemia in producing hyperventilation in paPatients with severe hyperventilation (P a CO 2°3 0 mm tients with cirrhosis. Hg) had statistically higher levels of progesterone and estradiol than did patients with mild hyperventilation PATIENTS AND METHODS (30 õ P a CO 2°3 5) or normal ventilation (P a CO 2 ú 35) (P õ .05). Although the progesterone levels were two orders With written patient consent and approval from the University of of magnitude lower than those associated with hyper-Rochester Investigational Review Board, we prospectively studied 50 ventilation in pregnant patients, the increased ventila-patients presenting to liver clinic for possible liver transplantation. tory effect may be because of the altered blood-brain Premenopausal women, patients with chronic obstructive pulmonary disease or acute encephalopathy, or patients taking hormonal medibarrier (BBB) present in cirrhotic patients. Progestercations, narcotics, or benzodiazepines were excluded. All patients one and estradiol appear to contribute to the hyperven- 58.)the wrist. A 20-gauge catheter was then placed in a sterile fashion into the radial artery and taped in place. To ensure no hyperventilation from anxiety or pain, arterial blood was drawn into a heparinized Respiratory alkalosis is common in patients with hepatic syringe after several minutes, the arterial blood was placed on ice, cirrhosis 1,2 although the cause has proved elusive. Proposed and sent to the lab for immediate determination of blood gas results.mechanisms include increased ammonia, 3 decreased albuBlood was also sent for determination of estradiol and progesterone min, 4 hypoxia, 5 and elevated progesterone. 6 levels. Albumin and bilirubin levels and prothrombin t...

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Section: )mentioning

confidence: 77%

Section: )mentioning

confidence: 91%

The hyperventilation of cirrhosis: Progesterone and estradiol effects

Lustik

1997

Hepatology

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“…Although the mild diffusion defect noted with both single breath and steady state carbon monoxide diffusion studies might be contributory, the authors feel that shunting of blood through the pulmonary vasculature, demonstrated by the 100-percent oxygen study, was the major factor leading to the hypoxemia in this patient with cirrhosis. Since the diffusion capacity remains normal in the presence of A-V shunts [3|, the diffusion defect noted here might be due to an element of fibrosing alveolotis [14,34], which has been described in association with cirrhosis. The absence of a lung biopsy relegates this diagnosis to the area of speculation.…”

Section: Severity Of Hypoxemiamentioning

confidence: 99%

“…The association of digital clubbing and cirrhosis of the liver has been known since 1884 [11], Arterial unsaturation and cirrhosis in the ab sence of pulmonary disease was first noted in 1935 [30], Abnormal be havior of hemoglobin [17], porto-pulmonary shunts [7,10,28,35], pul monary arterio-venous shunts [6,12,21,25,26], fibrosing alveolitis [14,34] and ventilation perfusion imbalance [19] have all been pro posed as possible mechanisms of the arterial unsaturation. The weight of evidence available at present supports the hypothesis of pulmonary arte rio-venous shunts as the major factor in the arterial unsaturation and hypoxemia associated with cirrhosis of the liver.…”

Section: Introductionmentioning

confidence: 99%

Cirrhosis of the Liver – an Unusual Cause of Severe Hypoxemia

Kaplan¹,

Laguarda²

1972

Respiration

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The association of digital clubbing and cirrhosis of the liver has been known since 1884. Arterial -unsaturation and cirrhosis in the absence of pulmonary disease was first noted in 1935. Abnormal behavior of hemoglobin, porto-pulmonary shunts, pulmonary arterio- venous shunts, fibrosing alveolitis and ventilation perfusion imbalance have all been proposed as possible mechanisms of the arterial unsaturation. The weight of evidence at present supports the hypothesis of pulmonary arterio-venous shunts as the major factor in the arterial unsaturation and hypoxemia associated with cirrhosis of the liver. This case emphasizes the severity of hypoxemia that can occur with liver disease and reviews the possible mechanisms involved.

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“…On the other hand, some cirrhotic patients in a pre-transplant stage frequently show "idiopathic" hyperventilation at rest, associated with hypocapnia and alkalosis, in absence of detectable organic cardiopulmonary dysfunction [1,3]. Several mechanisms, including hypoxemia, increased serum ammonia and hypoproteinemia have been proposed and rebutted [5][6][7].…”

Section: Introductionmentioning

confidence: 99%