Distúrbios ácido-base nas doenças hepáticas / Acid-base disorders in liver diseases

O objetivo deste artigo foi abordar as controvérsias científicas acerca dos distúrbios ácido-base nas doenças hepáticas. Nos estágios avançados da doença hepática, os distúrbios ácido-base atuam de forma complexa, comprometendo a qualidade de vida do paciente e desafiando o manejo clínico. A literatura apresenta a alcalose respiratória como uma das principais alterações, porém há uma longa discussão sobre o mecanismo fisiopatológico; em especial, citam-se a hipóxia, a hipocapnia e o nível de progesterona. Nas desordens metabólicas, com destaque para a acidose, os estudos apontam principalmente o lactato, os unmeasured ions ou íons não medidos e as alterações hidroeletrolíticas, mas cada componente desse sobressai-se dependendo da fase da doença estudada, compensada ou descompensada. As controvérsias dos distúrbios ácido-base nas doenças hepáticas devem-se ora à complexidade da fisiopatologia da própria doença, ora à necessidade de mais estudos esclarecedores.

The aim of this study is to address the scientific controversy about acid-base disorders in liver diseases. In the end stage of liver diseases, the acid-base disorder has a complex performance, impairing the patient's quality of life and challenging the clinic management. Although the literature shows respiratory alkalosis as one of the main alterations, there is a long discussion about the pathophysiological mechanism, specially regarding hypoxia, hypocapnia, and progesterone level. In metabolic disorders, especially acidosis, the studies mainly indicate the lactate, unmeasured ions, and hydroelectrolytic alterations, but, depending on the disease phase, either compensated or decompensated, each element has a particular action. The controversy about acid-base disorders in liver diseases is associated with the complexity of this condition, as well as with the necessity of more specialized research.

EXPERIMENTAL STUDY ON H~+/K~+ EXCHANGE FUNCTION AND cH-K-ATPase mRNA EXPRESSION IN RENAL IMCD CELL MONOLAYER UNDER RESPIRATORY ACID-BASE DISORDERS IN RABBIT / 解放军医学杂志

To study the cellular pathophysiological change in kidney IMCD cell under respiratory acid base disorders. 3% or 10% CO 2 was used to initiate chronic respiratory alkalosis(ALG) or chronic respiratory acidosis(ACG) of cultured rabbit IMCD cell. 5% CO 2 was used in control group(CG). Fluorescent probe was used to measure H + /K + exchange function of these cells. In situ hybridization and RT PCR were used to measure cH K ATPase mRNA expression of these cells.The results showed that H + /K + exchange in ACG was significantly higher than that in CG ( P 0 05). It is suggested that chronic respiratory acidosis could induce an increase in H + /K + exchange function and cH K ATPase mRNA expression. However, chronic respiratory alkalosis could induce decreases in H + /K + exchange function and cH K ATPase mRNA expression with no statistical significance, the reason of which calls for further study.