Equilibrium of acidifying and alkalinizing metabolic acid-base disorders in cirrhosis

Liver Int. 2005 Jun;25(3):505-12. doi: 10.1111/j.1478-3231.2005.01013.x.


Background and aims: Conflicting results exist with regard to metabolic acid-base status in liver cirrhosis, when the classic concept of acid-base analysis is applied. The influence of the common disturbances of water, electrolytes and albumin on acid-base status in cirrhosis has not been studied. The aim of this study was to clarify acid-base status in cirrhotic patients by analyzing all parameters with possible impact on acid-base equilibrium.

Patients and methods: Fifty stable cirrhotic patients admitted to a university hospital. Arterial acid-base status was analyzed using the principles of physical chemistry and compared with 10 healthy controls.

Results: Apart from mild hypoalbuminemic alkalosis, acid-base state was normal in Child-Pugh A cirrhosis. Respiratory alkalosis was the net acid-base disorder in Child-Pugh B and C cirrhosis with a normal overall metabolic acid-base state (Base excess-1.0 (-3.6 to 1.6) vs 1.1 (-0.2 to 1.1) mmol/l, P = 0.136, compared with healthy controls, median (interquartile range)). Absence of an apparent metabolic acid-base disorder was based on an equilibrium of hypoalbuminemic alkalosis and of dilutional acidosis and hyperchloremic acidosis.

Conclusion: A balance of offsetting acidifying and alkalinizing metabolic acid-base disorders leaves the net metabolic acid-base status unchanged in cirrhosis.

MeSH terms

  • Acid-Base Imbalance / drug therapy
  • Acid-Base Imbalance / etiology*
  • Acid-Base Imbalance / metabolism*
  • Acidosis / drug therapy
  • Acidosis / etiology
  • Acidosis / metabolism
  • Aged
  • Alkalosis / drug therapy
  • Alkalosis / etiology
  • Alkalosis / metabolism
  • Diuretics / therapeutic use
  • Electrolytes / blood
  • Female
  • Humans
  • Hydrogen-Ion Concentration
  • Liver Cirrhosis / complications*
  • Liver Cirrhosis / drug therapy
  • Liver Cirrhosis / metabolism*
  • Male
  • Middle Aged
  • Serum Albumin / metabolism
  • Severity of Illness Index


  • Diuretics
  • Electrolytes
  • Serum Albumin