Summary
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.
Keywords
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Article info
Publication history
Published online: July 03, 2017
Accepted:
June 27,
2017
Received in revised form:
June 21,
2017
Received:
February 27,
2017
Identification
Copyright
© 2017 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
