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
- Cl- replaces 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
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