Acid base and metabolic disturbances in fulminant hepatic failure

Abstract

In 28 patients with fulminant hepatic failure alkalaemia was present in 49 of a total of 65 observations. Alkalaemia was due primarily to a low PaCO2 in 30 instances and to raised plasma bicarbonate in 16 instances. Blood lactate, pyruvate, and acetoacetate were significantly raised, and in individual cases, blood citrate, succinate, and fumarate were elevated. Blood citrate rose progressively as the clinical condition worsened. Metabolic acidosis was only present in 4 patients. In 3 of these patients, all of whom had taken an overdose of paracetamol, the acidosis was severe, present before the onset of clinical hepatic failure, and associated with hypoglycaemia and mild hypotension. In 2 of these patients the acidosis was shown to be due to accumulation of lactic acid. Plasma free fatty acid concentrations were elevated out of proportion to the degree of ketosis.