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J Hepatol. 2006 Sep;45(3):387-92. Epub 2006 Apr 25.

The acidifying effect of lactate is neutralized by the alkalinizing effect of hypoalbuminemia in non-paracetamol-induced acute liver failure.

Author information

1
Klinik fuer Innere Medizin IV, ICU 13H1, Medical University of Vienna, Allgemeines Krankenhaus, Waehringerguertel 18-20, A - 1090 Vienna, Austria. georg-christian.funk@meduniwien.ac.at

Abstract

BACKGROUND/AIMS:

Hyperlactatemia with unexplained absence of metabolic acidosis is observed in acute liver failure. In chronic liver disease offsetting metabolic acid-base disorders could be revealed by means of physical-chemical acid-base analysis. The purpose of this study was to determine whether the acidifying effect of lactate is neutralized by the alkalinizing effect of hypoalbuminemia in acute liver failure.

METHODS:

Serial arterial blood samples of 46 consecutive patients with non-paracetamol-induced acute liver failure were studied after admission to a medical ICU in a prospective investigation and compared to healthy controls. Acid-base state was assessed by quantitative physical-chemical analysis.

RESULTS:

Lactate was increased and albumin was decreased in patients with acute liver failure compared to healthy controls resulting in normal net metabolic acid-base state. The alkalinizing effect of hypoalbuminemia was neutralized by the acidifying effect of elevated lactate. This observation was confirmed in serial analysis during 5 days after admission.

CONCLUSIONS:

The acidifying effect of lactate is neutralized by the alkalinizing effect of hypoalbuminemia in non-paracetamol-induced acute liver failure. The absence of apparent metabolic acidosis in the presence of elevated lactate can be explained by means of the physical-chemical acid-base model.

PMID:
16750869
DOI:
10.1016/j.jhep.2006.03.011
[Indexed for MEDLINE]

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