acid and base in liver disease

• related: GI

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