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


Authors: Jana Lůžková 1;  Bořivoj Lůžek 2;  Karel Matoušovic 3,4
Authors‘ workplace: 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: Vnitř Lék 2016; 62(Suppl 6): 14-20
Category: Original Contributions

Overview

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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