Vnitr Lek 2016, 62(Suppl 6):14-20

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

Jana Lůžková1, Bořivoj Lůžek2, Karel Matoušovic3,4,*
1 2. LF UK, Praha
2 I. interní oddělení nemocnice Most, o.z., Krajská zdravotní, a.s.
3 Interní klinika 2. LF UK a FN v Motole, Praha
4 Oddělení transplantací a tkáňové banky FN v Motole, Praha

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.

Keywords: acid-base balance; liver cirrhosis; sodium-chloride difference; Stewart-Fencl method

Received: September 1, 2016; Accepted: September 30, 2016; Published: December 1, 2016  Show citation

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Lůžková J, Lůžek B, Matoušovic K. [Na+] - [Cl-] difference significantly contributes to acidemia in patients with liver cirrhosis. Vnitr Lek. 2016;62(Supplementum 6):14-20.
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