Lactic acidosis and liver disease.

Area of Science:

• Hepatology
• Critical Care Medicine
• Biochemistry

Background:

• Hepatic insufficiency can lead to lactate accumulation and lactic acidosis.
• Distinguishing between acute and chronic hepatic insufficiency is crucial for prognosis and management.
• Lactic acidosis in liver disease requires careful evaluation of underlying causes and severity.

Purpose of the Study:

• To compare the clinical characteristics and outcomes of patients with acute versus chronic hepatic insufficiency presenting with lactic acidosis.
• To identify predictors of survival in patients with liver disease and lactic acidosis.

Main Methods:

• Retrospective comparison of patients with acute hepatic failure and chronic hepatic insufficiency.
• Analysis of hepatic function tests, precipitating events, and survival rates.
• Evaluation of the impact of glucose administration on lactate levels.

Main Results:

• Patients with chronic hepatic insufficiency often had an acute precipitating event (sepsis, GI hemorrhage) with less dramatic liver function test alterations and no long-term survivors.
• Patients with acute hepatic failure exhibited striking alterations in liver function tests, notably prolonged prothrombin time, with a 3/7 survival rate.
• Hypoglycemia was common in both groups; glucose administration rapidly lowered lactate in two acute cases.

Conclusions:

• Acute hepatic failure presents with more severe hepatic dysfunction and a better, though limited, survival rate compared to chronic hepatic insufficiency with precipitating events.
• Prothrombin time prolongation is an early and significant indicator in acute hepatic failure.
• Management of hypoglycemia and prompt identification of precipitating events are critical in patients with hepatic insufficiency and lactic acidosis.