Acid-base abnormalities and liver dysfunction

Ann Hepatol. 2022 Mar-Apr;27(2):100675. doi: 10.1016/j.aohep.2022.100675. Epub 2022 Jan 21.


In addition to the kidneys and lungs, the liver also plays an important role in the regulation of the Acid-Base Equilibrium (ABE). The involvement of the liver in the regulation of ABE is crucial because of its role in lactic acid metabolism, urea production and in protein homeostasis. The main acid-base imbalance that occurs in patients with liver cirrhosis is Respiratory Alkalosis (RAlk). Due to the fact that in these patients additional pathophysiological mechanisms that affect the ABE are present, other disorders may appear which compensate or enhance the primary disorder. Conventional ABE reading models fail to identify and assess the underlying disorders in patients with liver cirrhosis. This weakness of the classical models led to the creation of new physicochemical mathematical models that take into account all the known parameters that develop and affect the ABE. In addition to the RAlk, in patients with liver cirrhosis, metabolic alkalosis (due to hypoalbuminemia), hyponatremic metabolic acidosis, hyperchloremic metabolic acidosis, lactic acidosis and metabolic alkalosis due to urea metabolism are some of the pathophysiological mechanisms that affect the ABE.

Keywords: Acid-base equilibrium/acid-base balance; Hepatic diseases/liver cirrhosis.

Publication types

  • Review

MeSH terms

  • Acidosis* / etiology
  • Acidosis* / metabolism
  • Alkalosis* / complications
  • Alkalosis* / metabolism
  • Humans
  • Liver Cirrhosis / complications
  • Liver Cirrhosis / diagnosis
  • Liver Diseases* / metabolism
  • Urea


  • Urea