<abstract xmlns="http://www.w3.org/1999/xhtml"><p> Lactic acidosis (LA) in end-stage liver disease (ESLD) patients has been recognized as one of the most complicated clinical problems and is associated with increased morbidity and mortality. Multiple-organ failure, associated with advanced stages of cirrhosis, exacerbates dysfunction of numerous parts of lactate metabolism cycle, which manifests as increased lactate production and impaired clearance, leading to severe LA-induced acidemia. These problems become especially prominent in ESLD patients, that undergo partial hepatectomy and, particularly, liver transplantation. Perioperative management of LA and associated severe acidemia is an inseparable part of anesthesia, post-operative and critical care for this category of patients, presenting a wide variety of challenges. In this review, lactic acidosis applied pathophysiology, clinical implications for ESLD patients, diagnosis, role of intraoperative factors, such as anesthesia- and surgery-related, vasoactive agents impact, and also current treatment options and modalities have been discussed.</p></abstract>

Lactic acidosis (LA) in end-stage liver disease (ESLD) patients has been recognized as one of the most complicated clinical problems and is associated with increased morbidity and mortality. Multiple-organ failure, associated with advanced stages of cirrhosis, exacerbates dysfunction of numerous parts of lactate metabolism cycle, which manifests as increased lactate production and impaired clearance, leading to severe LA-induced acidemia. These problems become especially prominent in ESLD patients, that undergo partial hepatectomy and, particularly, liver transplantation. Perioperative management of LA and associated severe acidemia is an inseparable part of anesthesia, post-operative and critical care for this category of patients, presenting a wide variety of challenges. In this review, lactic acidosis applied pathophysiology, clinical implications for ESLD patients, diagnosis, role of intraoperative factors, such as anesthesia- and surgery-related, vasoactive agents impact, and also current treatment options and modalities have been discussed.

Review. Perioperative Management of Lactic Acidosis in End-Stage Liver Disease Patient

The Journal of Critical Care Medicine

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Lactic acidosis (LA) in end-stage liver disease (ESLD) patients has been recognized as one of the most complicated clinical problems and is associated with...

Review. Perioperative Management of Lactic Acidosis in End-Stage Liver Disease Patient

Published Online: May 11, 2017

Page range: 55 - 62

Received: Mar 10, 2017

Accepted: Apr 28, 2017

DOI: https://doi.org/10.1515/jccm-2017-0014

Keywords
lactic acidosis, end-stage liver disease, perioperative management, liver transplantation

© 2017

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Review. Perioperative Management of Lactic Acidosis in End-Stage Liver Disease Patient

Published Online: May 11, 2017

Page range: 55 - 62

Received: Mar 10, 2017

Accepted: Apr 28, 2017

DOI: https://doi.org/10.1515/jccm-2017-0014

Keywordslactic acidosis, end-stage liver disease, perioperative management, liver transplantation

© 2017

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Keywords
lactic acidosis, end-stage liver disease, perioperative management, liver transplantation