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

Authors

  • Richard Moreau,

    Corresponding author
    1. Service de Réanimation et de Médecine d'Urgence, Hôpital Emile-Roux, Eaubonne and Unité de Recherches de Physiopathologie Hépatique (INSERM U-24), Hôpital Beaujon, Clichy, France
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  • Antoine Hadengue,

    1. Service de Réanimation et de Médecine d'Urgence, Hôpital Emile-Roux, Eaubonne and Unité de Recherches de Physiopathologie Hépatique (INSERM U-24), Hôpital Beaujon, Clichy, France
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  • Thierry Soupison,

    1. Service de Réanimation et de Médecine d'Urgence, Hôpital Emile-Roux, Eaubonne and Unité de Recherches de Physiopathologie Hépatique (INSERM U-24), Hôpital Beaujon, Clichy, France
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  • Marie-France Mamzer,

    1. Service de Réanimation et de Médecine d'Urgence, Hôpital Emile-Roux, Eaubonne and Unité de Recherches de Physiopathologie Hépatique (INSERM U-24), Hôpital Beaujon, Clichy, France
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  • Philippe Kirstetter,

    1. Service de Réanimation et de Médecine d'Urgence, Hôpital Emile-Roux, Eaubonne and Unité de Recherches de Physiopathologie Hépatique (INSERM U-24), Hôpital Beaujon, Clichy, France
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  • Jean-Luc Saraux,

    1. Service de Réanimation et de Médecine d'Urgence, Hôpital Emile-Roux, Eaubonne and Unité de Recherches de Physiopathologie Hépatique (INSERM U-24), Hôpital Beaujon, Clichy, France
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  • Michel Assous,

    1. Service de Réanimation et de Médecine d'Urgence, Hôpital Emile-Roux, Eaubonne and Unité de Recherches de Physiopathologie Hépatique (INSERM U-24), Hôpital Beaujon, Clichy, France
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  • Jacqueline Roche-Sicot,

    1. Service de Réanimation et de Médecine d'Urgence, Hôpital Emile-Roux, Eaubonne and Unité de Recherches de Physiopathologie Hépatique (INSERM U-24), Hôpital Beaujon, Clichy, France
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  • Christian Sicot

    1. Service de Réanimation et de Médecine d'Urgence, Hôpital Emile-Roux, Eaubonne and Unité de Recherches de Physiopathologie Hépatique (INSERM U-24), Hôpital Beaujon, Clichy, France
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Service de Réanimation et de Médecine d'Urgence, Hôpital Emile-Roux, 95602 Eaubonne Cedex, France

Abstract

ABSTRACT— 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 hypobicar-bonataemia. 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.

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