PT - JOURNAL ARTICLE AU - C O Record AU - R A Iles AU - R D Cohen AU - R Williams TI - Acid-base and metabolic disturbances in fulminant hepatic failure. AID - 10.1136/gut.16.2.144 DP - 1975 Feb 01 TA - Gut PG - 144--149 VI - 16 IP - 2 4099 - http://gut.bmj.com/content/16/2/144.short 4100 - http://gut.bmj.com/content/16/2/144.full SO - Gut1975 Feb 01; 16 AB - In 28 patients with fulminant hepatic failure alkalaemia was present in 49 of a total of 65 observations. Alkalaemia was due primarlily to a low Pa, C02 in 30 instances and to raised plasma bicarbonate in 16 instances. Blood lactate, pyruvate, and acetoacetate were significantly raised, and in individual cases, blood citrate, succinate, and fumarate were elevated. Blood citrate rose progressively as the clinical condition worsened. Metabolic acidosis was only present in four patients. In three of these patients, all of whom had taken an overdose of paracetamol, the acidosis was severe, present before the onset of clinical heparic failure, and associated with hypoglycaemiaand mild hypotension. In two of these patients the acidosis was shown to be due to accumulation of lactic acid. Plasma free fatty acid concentrations were elevated out of proportion to the degree of ketosis.