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Related Concept Videos

Disorders of Acid-Base Balance01:29

Disorders of Acid-Base Balance

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The human body maintains a precise pH range of arterial blood between 7.35 and 7.45. Deviations result in either acidosis (pH < 7.35) or alkalosis (pH > 7.45). These conditions are further classified as respiratory or metabolic disorders based on their underlying cause.
Respiratory Acidosis and Alkalosis
Respiratory acidosis occurs due to an increase in the partial pressure of carbon dioxide PCO2 in the blood. It often arises from shallow breathing or impaired gas exchange caused by...
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Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test01:22

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In clinical practice, the direct measurement of hepatic blood flow to evaluate liver function presents significant challenges due to the intricate and specialized nature of the necessary techniques. Consequently, healthcare professionals often rely on empirical estimates derived from thorough patient examinations and liver function tests to gauge liver health. Among the tools at their disposal, the Child–Pugh and MELD scoring systems stand out for their ability to categorize and assess...
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Diagnosing Acidosis and Alkalosis01:24

Diagnosing Acidosis and Alkalosis

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Diagnosing acid-base imbalances involves systematically analyzing arterial blood samples, focusing on three key measurements: pH, bicarbonate (HCO3−) concentration, and carbon dioxide partial pressure (PCO2). This analysis follows a four-step process that helps identify the imbalance's underlying cause and nature.
First, the pH level is assessed to determine whether the blood pH is normal (7.35–7.45), low (acidosis), or high (alkalosis).
Next, the PCO2  and...
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Acid-Base Balance01:25

Acid-Base Balance

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The human body maintains a narrow pH range regulated through acid-base balance. This balance is crucial as changes in the hydrogen ion concentration can disrupt cell membrane stability, alter protein structures, and change enzyme activities. The normal pH of arterial blood is 7.4, venous blood and interstitial fluid is 7.35, and intracellular fluid averages 7.0.
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Bronsted-Lowry Acids and Bases02:58

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The acid-base reaction class has been studied for quite some time. In 1680, Robert Boyle reported traits of acid solutions that included their ability to dissolve many substances, to change the colors of certain natural dyes, and to lose these traits after coming in contact with alkali (base) solutions. In the eighteenth century, it was recognized that acids have a sour taste, react with limestone to liberate a gaseous substance (now known to be CO2), and interact with alkalis to form neutral...
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Effect of Hepatic Disease on Pharmacokinetics: Drug Dosing and Hepatic Blood Flow01:26

Effect of Hepatic Disease on Pharmacokinetics: Drug Dosing and Hepatic Blood Flow

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Chronic liver disease significantly impacts drug metabolism due to alterations in hepatic blood flow and enzyme accessibility. This disruption affects the body's pharmacokinetics—the movement and processing of drugs within the system. Key enzymes crucial for metabolizing medications become less accessible, changing how drugs are processed and utilized. Furthermore, liver disease influences the synthesis of plasma proteins, such as albumin and globulins, which play critical roles in drug...
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Acid-base disorders in liver disease.

Bernhard Scheiner1, Gregor Lindner2, Thomas Reiberger3

  • 1Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria; Department of Respiratory and Critical Care Medicine, Otto Wagner Spital, Vienna, Austria.

Journal of Hepatology
|July 8, 2017
PubMed
Summary

Liver dysfunction can cause complex acid-base disorders. The physical-chemical model aids diagnosis in liver disease patients, revealing hidden metabolic abnormalities crucial for treatment.

Keywords:
Acid-base disordersAcute liver failureCirrhosisCritically-illLiver disease

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Area of Science:

  • Nephrology and Hepatology
  • Physiology
  • Clinical Chemistry

Background:

  • The liver is a key regulator of acid-base homeostasis alongside the kidneys and lungs.
  • Respiratory alkalosis is common in chronic liver disease, but metabolic acid-base disorders also occur.
  • Standard acid-base variables (pH, base excess) may not reveal the cause of disorders in liver disease.

Purpose of the Study:

  • To highlight the utility of the physical-chemical acid-base model for assessing liver disease patients.
  • To describe the complex, often offsetting, metabolic acid-base disorders in chronic and acute liver conditions.
  • To emphasize the importance of understanding these abnormalities for clinical decision-making.

Main Methods:

  • Application of the physical-chemical acid-base model for in-depth pathophysiological assessment.
  • Analysis of acid-base status in patients with stable chronic liver disease, critically ill cirrhotic patients, and acute liver failure.
  • Evaluation of standard acid-base parameters versus the physical-chemical approach.

Main Results:

  • Stable chronic liver disease patients exhibit offsetting disorders (hypoalbuminemic alkalosis vs. hyperchloremic/dilutional acidosis), often masking a normal base excess.
  • Critically ill cirrhotic patients frequently develop metabolic acidosis (lactic acidosis, unmeasured anions).
  • Acute liver failure patients with high lactate may show no overt acid-base disorder due to concurrent hypoalbuminemic alkalosis.

Conclusions:

  • Liver disease patients frequently present with multiple, co-existing metabolic acid-base abnormalities.
  • The physical-chemical model offers superior insight into the complex acid-base disturbances in liver disease.
  • Accurate diagnosis of these abnormalities is critical for effective therapeutic strategies in patients with liver disease.