Na+- [Cl-difference significantly contributes to acidemia in patients with liver cirrhosis

To evaluate the role of strong ion difference (SID) in acid-base disorders in patients with liver disease. We evaluated the acid-base status in 11 patients with liver cirrhosis both by traditional and quantitative Stewart-Fencl methods. Nine of eleven patients had pH within the norm, 2/11 had pH above 7.44. One patient had respiratory alkalosis, the second had a combined respiratory alkalemia and metabolic acidemia. The anion gap was increased only in one patient, but after correction for serum albumin concentration, it was above the norm in 10/11 patients. pCO2 was below the normal limit in 5/11 patients. The Stewart-Fencl evaluation revealed decreased SID in 11/11 patients. Both SID and the difference in [Na+] - [Cl-] closely correlated with [HCO3-] (r = 0.9264 and r = 0.7272, respectively, P < 0.01). The not routinely assayed ions [UA-] were increased in 9/11 patients. The acid-base status in patients with decompensated liver cirrhosis was characterized by a tend-ency to respiratory alkalemia and metabolic acidemia. Apart from an increase of [UA-], the difference in [Na+] - [Cl-] con-tributed significantly to acidemia. Thus, this simple parameter aids in determining the causes of acid-base disturbance and influences the treatment strategy.Key words: acid-base balance - liver cirrhosis - sodium-chloride difference - Stewart-Fencl method.