Arterial and mixed venous acid-base status in patients with cirrhosis. Influence of liver failure

• Published in: Liver (Copenhagen) Vol. 13; no. 1; p. 20
• Main Authors: Moreau, R, Hadengue, A, Soupison, T, Mamzer, M F, Kirstetter, P, Saraux, J L, Assous, M, Roche-Sicot, J, Sicot, C
• Format: Journal Article
• Language: English
• Published: Denmark 01-02-1993
• Subjects: Alkalosis, Respiratory - etiology; Bicarbonates - blood; Blood Gas Analysis; Female; Humans; Hydrogen-Ion Concentration; Hypocapnia - etiology; Liver Cirrhosis - blood; Liver Cirrhosis - complications; Liver Failure - blood; Liver Failure - complications; Male; Middle Aged
• ISSN: 0106-9543
• DOI: 10.1111/j.1600-0676.1993.tb00600.x

Although it has been established that liver failure is associated with arterial hypocapnia and alkalaemia (i.e., respiratory alkalosis), the influence of liver failure on mixed venous acid-base status has not yet been studied. Thus, arterial and mixed venous acid-base status were simultaneously measured in controls and in a large series of patients with cirrhosis. Grade B patients (n = 28) or Grade C patients (n = 21) had significantly lower arterial and mixed venous carbon dioxide tensions than controls (n = 29). Grade B or Grade C patients also had significantly higher arterial, mixed venous pH, and lower mixed venous bicarbonate concentrations than controls. Among Grade A patients (n = 27), those with the lowest Pugh's score (i.e., equal to five) had significantly lower mixed venous carbon dioxide tension than controls. The other arterial and mixed venous acid-base values did not differ significantly between Grade A patients with the lowest Pugh's score and controls. Grade A patients with a Pugh's score equal to six and Grade B patients had similar acid-base disorders. No significant differences were found between groups concerning the anion gap and plasma chloride concentrations. In conclusion, this study shows that in Grade B or C patients, respiratory alkalosis was responsible for mixed venous hypocapnia, alkalaemia and hypobicarbonataemia. In addition, in Grade A patients with the lowest Pugh's score (equal to five), analysis of arterial and mixed venous blood revealed that mixed venous hypocapnia was the sole anomaly of the acid-base status. This last finding suggests that mixed venous hypocapnia might be an early event preceding the onset of arterial hypocapnia.