The acidifying effect of lactate is neutralized by the alkalinizing effect of hypoalbuminemia in non-paracetamol-induced acute liver failure

J Hepatol. 2006 Sep;45(3):387-92. doi: 10.1016/j.jhep.2006.03.011. Epub 2006 Apr 25.

Abstract

Background/aims: Hyperlactatemia with unexplained absence of metabolic acidosis is observed in acute liver failure. In chronic liver disease offsetting metabolic acid-base disorders could be revealed by means of physical-chemical acid-base analysis. The purpose of this study was to determine whether the acidifying effect of lactate is neutralized by the alkalinizing effect of hypoalbuminemia in acute liver failure.

Methods: Serial arterial blood samples of 46 consecutive patients with non-paracetamol-induced acute liver failure were studied after admission to a medical ICU in a prospective investigation and compared to healthy controls. Acid-base state was assessed by quantitative physical-chemical analysis.

Results: Lactate was increased and albumin was decreased in patients with acute liver failure compared to healthy controls resulting in normal net metabolic acid-base state. The alkalinizing effect of hypoalbuminemia was neutralized by the acidifying effect of elevated lactate. This observation was confirmed in serial analysis during 5 days after admission.

Conclusions: The acidifying effect of lactate is neutralized by the alkalinizing effect of hypoalbuminemia in non-paracetamol-induced acute liver failure. The absence of apparent metabolic acidosis in the presence of elevated lactate can be explained by means of the physical-chemical acid-base model.

MeSH terms

  • Acetaminophen / adverse effects
  • Acid-Base Equilibrium
  • Acidosis / etiology
  • Acidosis / metabolism
  • Acidosis / physiopathology
  • Adult
  • Albumins / metabolism
  • Analgesics, Non-Narcotic / adverse effects
  • Case-Control Studies
  • Female
  • Humans
  • Hypoalbuminemia / etiology*
  • Hypoalbuminemia / metabolism*
  • Hypoalbuminemia / physiopathology
  • Incidence
  • Lactates / metabolism*
  • Liver Failure, Acute / etiology*
  • Liver Failure, Acute / metabolism*
  • Liver Failure, Acute / physiopathology
  • Male
  • Middle Aged
  • Prospective Studies

Substances

  • Albumins
  • Analgesics, Non-Narcotic
  • Lactates
  • Acetaminophen