acid and base in liver disease

Alkalosis

  • cirrhosis pts have respiratory alkalosis
    • ascites/hydrothorax causes hyperventilation
    • hyperammonaemia and hepatic encephalopathy also cause hyperventilation
  • decreased albumin causes alkalosis
    • albumin is weak acid
    • 1g decrease in albumin causes base excess of 3

Acidosis

  • Hyponatremia is related to acidosis
    • free water pH 7.0 dilutes blood pH 7.4
    • repeat paracentesis causes increased free water retention and can exacerbate hyponatremia
  • Hyperchloridemia causes acidosis
    • Clreplaces HCO3-
    • chronic respiratory alkalosis: kidney starts excreting more HCO3 in response and decreases NH4Cl secretion
    • diarrhea
  • Lactic acidosis
    • 95% metabolized by liver
    • 5% by kidney, worsened with AKI