[Na⁺] – [Cl^-] difference significantly contributes to acidemia in patients with liver cirrhosis

Česká verzia

Authors: Jana Lůžková ¹; Bořivoj Lůžek ²; Karel Matoušovic ^3,4
Authors place of work: 2. LF UK, Praha ¹; I. interní oddělení nemocnice Most, o. z., Krajská zdravotní, a. s. ²; Interní klinika 2. LF UK a FN v Motole, Praha ³; Oddělení transplantací a tkáňové banky FN v Motole, Praha ⁴
Published in the journal: Vnitř Lék 2016; 62(Suppl 6): 14-20
Category: Original Contributions

Summary

Aim:
To evaluate the role of strong ion difference (SID) in acid-base disorders in patients with liver disease.

Patients and methods:
We evaluated the acid-base status in 11 patients with liver cirrhosis both by traditional and quantitative Stewart-Fencl methods.

Results:
Nine of eleven patients had pH within the norm, 2/11 had pH above 7.44. One patient had respiratory alkalosis, the second had a combined respiratory alkalemia and metabolic acidemia. The anion gap was increased only in one patient, but after correction for serum albumin concentration, it was above the norm in 10/11 patients. pCO₂ was below the normal limit in 5/11 patients. The Stewart-Fencl evaluation revealed decreased SID in 11/11 patients. Both SID and the difference in [Na⁺] – [Cl^-] closely correlated with [HCO₃^-] (r = 0.9264 and r = 0.7272, respectively, P < 0.01). The not routinely assayed ions [UA^-] were increased in 9/11 patients.

Conclusion:
The acid-base status in patients with decompensated liver cirrhosis was characterized by a tendency to respiratory alkalemia and metabolic acidemia. Apart from an increase of [UA^-], the difference in [Na⁺] – [Cl^-] contributed significantly to acidemia. Thus, this simple parameter aids in determining the causes of acid-base disturbance and influences the treatment strategy.

Key words:
acid-base balance – liver cirrhosis – sodium-chloride difference – Stewart-Fencl method

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