Acid-base Disturbance in Hepatic Encephalopathy: An Analysis of 33 Cases / 第三军医大学学报

ABSTRACT

In order to evaluate the clinical significance of the acid-base disturbance complicating hepatic encephalopathy, arterial blood gas and electrolyte levels were determined in 33 patients with encephalopathy due to various hepatic disorders. It was found the respiratory alkalosis occurred in 31 cases(93.9%) and respiratory acidosis complicated with metabolic acidosis in 2 cases (6.06%). In the 31 cases of respiratory alkalosis, there were 4 cases(12.12%) of simple respiratory alkalosis, 18 cases(54.55%) complicated with metabolic alkalosis, 3 cases(9.09%) complicated with metabolic acidosis, and 6 cases complicated with both metabolic alkalosis and acidosis. In addition, the arterial blood pH of 29 cases (87.87%) was above the normal value of 7.45. The main type of acid-base disturbance found in hepatic encephalopathy was alkalosis. Its occurrence was closely related to hypoxemia, hyperammonemia, and elevated blood level of progesterone in the case of respiratory alkalosis and to salt-limited diet and improper administration of diuretics and alkalite drugs in the case of metabolic alkalosis. Metabolic acidosis was usually the result of severe complitions. In alkalosis, there was frequently an elevation of blood free ammonia, which could penetrate the blood-brain barrier easily and induce coma and encephalopathy. Therefore energetic correction of alkalosis would be valuable to prevent hepatic encephalopathy. Effective treatment of the primary disease, correction of hyperventilation.correction of disturbances of blood electrolytes, and administration of arginine hydrochloride and potasium chloride would be appropriate measures in dealing with alkalosis.