Electrolyte and Acid-Base Disturbances in End-Stage Liver Disease: A Physiopathological Approach

Digestive Diseases and Sciences
José Víctor JiménezEduardo Carrillo-Maravilla

Abstract

Electrolyte and acid-base disturbances are frequent in patients with end-stage liver disease; the underlying physiopathological mechanisms are often complex and represent a diagnostic and therapeutic challenge to the physician. Usually, these disorders do not develop in compensated cirrhotic patients, but with the onset of the classic complications of cirrhosis such as ascites, renal failure, spontaneous bacterial peritonitis and variceal bleeding, multiple electrolyte, and acid-base disturbances emerge. Hyponatremia parallels ascites formation and is a well-known trigger of hepatic encephalopathy; its management in this particular population poses a risky challenge due to the high susceptibility of cirrhotic patients to osmotic demyelination. Hypokalemia is common in the setting of cirrhosis: multiple potassium wasting mechanisms both inherent to the disease and resulting from its management make these patients particularly susceptible to potassium depletion even in the setting of normokalemia. Acid-base disturbances range from classical respiratory alkalosis to high anion gap metabolic acidosis, almost comprising the full acid-base spectrum. Because most electrolyte and acid-base disturbances are managed in terms of their und...Continue Reading

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Citations

Mar 7, 2020·Pediatric Transplantation·Renata Silva Duarte Dos SantosSandra Maria Gonçalves Vieira
Jul 7, 2020·Middle East Journal of Digestive Diseases·Delara GholamipoorMehrnaz Asadi Gharabaghi
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May 8, 2019·Clinical Liver Disease·Bashar Attar
Sep 30, 2019·Clinics in Liver Disease·Melissa Wong, Ronald W Busuttil
Feb 9, 2021·JGH Open : an Open Access Journal of Gastroenterology and Hepatology·Kosuke KajiHitoshi Yoshiji
May 6, 2021·Journal of Clinical Laboratory Analysis·JianJiang HuangXia He
Jun 1, 2021·Canadian Journal of Gastroenterology & Hepatology·Michael SchopisSamuel Sigal

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