Abstract
Recently plasma exchange (PE) with fresh frozen plasma (FFP) as replacement fluid has been widely applied in the treatment of hepatic failure patients. Since hepatic failure patients have a tendency foward alkalosis and hypernatremia, and FFP contains a large amount of citric acid and sodium, the alkalosis and hypernatremia can be worsened by PE in hepatic failure patients. In this study, the side effects of PE with special reference to that on acid-base balance and the beneficial effects of hemodialysis (HD) to correct those side effects were determined.
Of the 29 hepatic failure patients entering the study, 14 had viral hepatitis, 3 had drug-induced hepatitis, 3 cases had acute hepatic failure due to other causes, and 9 had postoperative hyperbilirubinemia. Blood gas analysis (BGA) and blood electrolyte analysis were performed before and after PE. Before PE (mean±SE, n=44), the pH was 7.47±0.01, HCO3- (mEq/l) was 27.4±0.7, BE (mEq/l) was 4.31±0.58, pCO2 (mmHg) was 38±1 and pO2 (mmHg) was 104±5, and after PE (n=44), the pH was 7.50±0.01, HCO3- was 28.8±0.8, BE was 6.10±0.50, pCO2 was 37±1 and pO2 was 109±6. These data indicate that PE worsened the alkalosis in hepatic failure patients.
Among the 29 patients, 5 patients had severe alkalosis and hypernatremia following the PE. For these patients, HD was performed 7 times to correct the PE. Before HD (equivalent to post PE), the pH ranged from 7.409 to 7.580, HCO3- ranged from 25.7 to 31.8, BE ranged from 3.8 to 9.6, and Na (mEq/l) ranged from 153 to 162. After HD, the pH ranged from 7.409 to 7.495, HCO3- ranged from 23.4 to 29.1, BE ranged from 1.3 to 4.5 and Na ranged from 140 to 155. These data indicate a beneficial effect of HD on alkalosis and hypernatremia after PE among hepatic failure patients.
