Document Detail

Acid-base balance during continuous veno-venous hemofiltration: the impact of severe hepatic failure.
MedLine Citation:
PMID:  16874671     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Continuous renal replacement therapy (CRRT) affects acid-base balance but the influence of severe hepatic failure (SHF) on this effect is unknown.
AIM: To assess the effect of SHF on acid-base balance in patients receiving CVVH.
DESIGN: Retrospective laboratory investigation.
SUBJECTS: Forty patients with SHF and acute renal failure (ARF) treated with CVVH and 42 critically ill patients with severe ARF but no liver disease also treated with CVVH (controls).
INTERVENTION: Retrieval of clinical and laboratory data from prospective unit and laboratory databases.
METHODS: Quantitative acid-base status assessment using the Stewart-Figge methodology. Comparison of findings between the two groups.
RESULTS: Although CVVH had a major effect on acid base balance in both groups, patients with SHF had a higher mean lactate concentrations (4.8 vs. 3.1 mmol/L; p<0.0005), a greater base deficit compared to controls (-1 vs. 4.1 mEq/L; p<0.0001) and a lower PaCO 2 tension (36.8 vs. 42.5 mmHg; p<0.0001), despite the use of bicarbonate replacement fluid. The acidifying effect of hyperlactatemia was slightly worsened by an increased strong ion gap (9.3 vs. 4.9 mEq/L; p<0.0001). It was, however, attenuated by an increased strong ion difference apparent (SIDa) (43.6 vs. 41.9 mEq/L; p<0.05) secondary to hypochloremia (96 vs. 100 mmol/L; p<0.0001) and by hypoalbuminemia, although hypoalbuminemia in SHF patients (26 vs. 23; p<0.005) was less pronounced than in controls.
CONCLUSION: The use of CVVH does not fully correct the independent acidifying effect of liver failure on acid-base status. Increased lactate and strong ion gap values maintain a persistent base deficit despite the alkalinizing effects of hypoalbuminemia and hypochloremia. The correction of acidosis in SHF patients may require more intensive CVVH.
T Naka; R Bellomo; H Morimatsu; J Rocktaschel; L Wan; P Gow; P Angus
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The International journal of artificial organs     Volume:  29     ISSN:  0391-3988     ISO Abbreviation:  Int J Artif Organs     Publication Date:  2006 Jul 
Date Detail:
Created Date:  2006-07-28     Completed Date:  2006-12-05     Revised Date:  2014-07-29    
Medline Journal Info:
Nlm Unique ID:  7802649     Medline TA:  Int J Artif Organs     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  668-74     Citation Subset:  IM    
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MeSH Terms
Acid-Base Equilibrium*
Acute Kidney Injury / physiopathology,  therapy
Critical Illness
Liver Failure / physiopathology*,  therapy
Middle Aged
Retrospective Studies

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