{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T07:54:18Z","timestamp":1789890858169,"version":"4.0.1"},"reference-count":36,"publisher":"BMJ","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Gut"],"published-print":{"date-parts":[[1975,2]]},"abstract":"<jats:p>In 28 patients with fulminant hepatic failure alkalaemia was present in 49 of a total of 65 observations. Alkalaemia was due primarlily to a low Pa, C02 in 30 instances and to raised plasma bicarbonate in 16 instances. Blood lactate, pyruvate, and acetoacetate were significantly raised, and in individual cases, blood citrate, succinate, and fumarate were elevated. Blood citrate rose progressively as the clinical condition worsened. Metabolic acidosis was only present in four patients. In three of these patients, all of whom had taken an overdose of paracetamol, the acidosis was severe, present before the onset of clinical heparic failure, and associated with hypoglycaemiaand mild hypotension. In two of these patients the acidosis was shown to be due to accumulation of lactic acid. Plasma free fatty acid concentrations were elevated out of proportion to the degree of ketosis.<\/jats:p>","DOI":"10.1136\/gut.16.2.144","type":"journal-article","created":{"date-parts":[[2007,9,18]],"date-time":"2007-09-18T17:41:31Z","timestamp":1190137291000},"page":"144-149","source":"Crossref","is-referenced-by-count":110,"title":["Acid-base and metabolic disturbances in fulminant hepatic failure."],"prefix":"10.1136","volume":"16","author":[{"given":"C O","family":"Record","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R A","family":"Iles","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R D","family":"Cohen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R","family":"Williams","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[1975,2,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1111\/j.1365-2362.1974.tb00386.x","article-title":"The kinetics of plasma free fatty acid and triglyceride transport in patients with idiopathic hypertriglyceridaemia and their relation to carbohydrate metabolism","volume":"4","author":"Adams, P.W.; Kissebah, A.H.; Harrigan, P.; Stokes, T.; Wynn, V.","year":"1974","unstructured":"Adams, P. W., Kissebah, A. H., Harrigan, P., Stokes, T., and Wynn, V. (1974). The kinetics of plasma free fatty acid and triglyceride transport in patients with idiopathic hypertriglyceridaemia and their relation to carbohydrate metabolism. Europ. J. clin. Invest., 4, 149-161.","journal-title":"Europ. J. clin. Invest"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1486","DOI":"10.1172\/JCI102389","article-title":"A study of pyruvic acid in the blood and spinal fluid of patients with liver disease with and without hepatic coma","volume":"29","author":"Amatuzio, D.S.; Nesbitt, S.","year":"1950","unstructured":"Amatuzio, D. S., and Nesbitt, S. (1950). A study of pyruvic acid in the blood and spinal fluid of patients with liver disease with and without hepatic coma. J. clin. Invest., 29, 1486-1490.","journal-title":"J. clin. Invest"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/0003-2697(68)90032-8","article-title":"A method for estimation of Krebs cycle and related intermediates in animal tissues by gas chromatography","volume":"26","author":"Barnett, D.; Cohen, R.D.; Tassopoulos, C.N.; Turtle, J.R.; Dimitriadou, A.; Fraser, T.R.","year":"1968","unstructured":"Barnett, D., Cohen, R. D., Tassopoulos, C. N., Turtle, J. R., Dimitriadou, A., and Fraser, T. R. (1968). A method for estimation of Krebs cycle and related intermediates in animal tissues by gas chromatography. Analyt. Biochem., 26, 68-84.","journal-title":"Analyt. Biochem"},{"key":"ref_4","first-page":"324","volume-title":"Methods of Enzymatic Analysis","author":"Bergmeyer, H.U.; Bernt, E.","year":"1963","unstructured":"Bergmeyer, H. U., and Bernt, E. (1963). In Methods of Enzymatic Analysis, edited by H. U. Bergmeyer, p. 324. Verlag Chemie, Weinheim. Academic Press, New York and London."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1016\/S0016-5085(65)80138-X","article-title":"Body and serum potassium in liver disease: 1. Relationship to hepatic function and associated factors","volume":"48","author":"Casey, T.H.; Summerskill, W.H.J.; Orvis, A.L.","year":"1965","unstructured":"Casey, T. H., Summerskill, W. H. J., and Orvis, A. L. (1965). Body and serum potassium in liver disease: 1. Relationship to hepatic function and associated factors. Gastroenterology, 48, 198-207.","journal-title":"Gastroenterology"},{"key":"ref_6","first-page":"392","article-title":"Blood pyruvic-acid and alpha-ketoglutaric-acid levels in liver disease and hepatic coma","volume":"1","author":"Dawson, A.M.; De Groote, J.; Rosenthal, W.S.; Sherlock, S.","year":"1957","unstructured":"Dawson, A. M., De Groote, J., Rosenthal, W. S., and Sherlock, S. (1957). Blood pyruvic-acid and alpha-ketoglutaric-acid levels in liver disease and hepatic coma. Lancet, 1, 392-396.","journal-title":"Lancet"},{"key":"ref_7","first-page":"262267","article-title":"Eine neue Bestimmung der Neutralfette im Blutserum und Gewebe","volume":"44","author":"Eggstein, M.; Kreutz, F.H.","year":"1966","unstructured":"Eggstein, M., and Kreutz, F. H. (1966). Eine neue Bestimmung der Neutralfette im Blutserum und Gewebe. 1, Prinzip, Durchfuhrung und Besprechung der Methode. Klin. Wschr., 44, 262267.","journal-title":"Klin. Wschr; Prinzip, Durchfuhrung und Besprechung der Methode"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1016\/0002-9343(60)90187-X","article-title":"Hyperventilation and arterial hypoxemia in cirrhosis of the liver","volume":"28","author":"Heinemann, H.O.; Emirgil, C.; Mijnssen, J.P.","year":"1960","unstructured":"Heinemann, H. O., Emirgil, C., and Mijnssen, J. P. (1960). Hyperventilation and arterial hypoxemia in cirrhosis of the liver. Amer. J. Med., 28, 239-246.","journal-title":"Amer. J. Med"},{"key":"ref_9","article-title":"tJber Metabolitgehalte und Metaboltikonzentrationen in der Leber der","author":"Hohorst, H.J.; Kreutz, F.H.; Bucher, T.","year":"1959","unstructured":"Hohorst, H. J., Kreutz, F. H., and Bucher, T. (1959). tJber Metabolitgehalte und Metaboltikonzentrationen in der Leber der"},{"key":"ref_10","article-title":"The plasma amino acids in patients with liver failure","author":"Iber, F.L.; Rosen, H.; Levenson, S.H.; Chalmers, T.C.","year":"1957","unstructured":"Iber, F. L., Rosen, H., Levenson, S. H., and Chalmers, T. C. (1957). The plasma amino acids in patients with liver failure. J. Lab."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1042\/cs0420035","article-title":"The effect of hypoxia on succinate metabolism in man and the isolated perfused dog liver","volume":"42","author":"Iles, R.A.; Barnett, D.; Strunin, L.; Strunin, J.M.; Simpson, B.R.; Cohen, R.D.","year":"1972","unstructured":"Iles, R. A., Barnett, D., Strunin, L., Strunin, J. M., Simpson, B. R., and Cohen, R. D. (1972). The effect of hypoxia on succinate metabolism in man and the isolated perfused dog liver. Clin. Sci., 42, 35-45.","journal-title":"Clin. Sci"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/S0022-2275(20)39633-4","article-title":"Colorimetric determination of free fatty acids in biological fluids","volume":"6","author":"Itaya, K.; Ui, M.","year":"1965","unstructured":"Itaya, K., and Ui, M. (1965). Colorimetric determination of free fatty acids in biological fluids. J. Lipid Res., 6, 16-20.","journal-title":"J. Lipid Res"},{"key":"ref_13","first-page":"312","article-title":"Eine enzymatische Mikrobestimmung des ammoniaks, geeignet fur Extrakte tierischer Gewebe und Flussigkeiten","volume":"337","author":"Kirsten, E.; Gerez, C.; Kirsten, R.","year":"1963","unstructured":"Kirsten, E., Gerez, C., and Kirsten, R. (1963). Eine enzymatische Mikrobestimmung des ammoniaks, geeignet fur Extrakte tierischer Gewebe und Flussigkeiten. Biochem. Z., 337, 312-319.","journal-title":"Biochem. Z"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1016\/S0016-5085(62)80119-X","article-title":"Alterations in serum triglyceride levels in liver disease","volume":"42","author":"Mendenhall, C.L.; Mortiaux, A.","year":"1962","unstructured":"Mendenhall, C. L., and Mortiaux, A. (1962). Alterations in serum triglyceride levels in liver disease. Gastroenterology, 42, 684-685.","journal-title":"Gastroenterology"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1136\/gut.2.4.304","article-title":"Plasma free fatty acid in liver disease","volume":"2","author":"Mortiaux, A.; Dawson, A.M.","year":"1961","unstructured":"Mortiaux, A., and Dawson, A. M. (1961). Plasma free fatty acid in liver disease. Gut, 2, 304-309.","journal-title":"Gut"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1097\/00005792-196703000-00010","article-title":"Acidbase disturbances in patients with cirrhosis of the liver","volume":"46","author":"Mulhausen, R.; Eichenholz, A.; Blumentals, A.","year":"1967","unstructured":"Mulhausen, R., Eichenholz, A., and Blumentals, A. (1967). Acidbase disturbances in patients with cirrhosis of the liver. Medicine (Baltimore), 46, 185-189.","journal-title":"Medicine (Baltimore)"},{"key":"ref_17","author":"Opolon, P.; Hadchouel, P.; Del Corso, A.; Caroli, J.","year":"1970","unstructured":"Opolon, P., Hadchouel, P., Del Corso, A., and Caroli, J. (1970)."},{"key":"ref_18","author":"Perret, A.; Enrico, J.F.; Montani, S.; Pappalardo, G.","year":"1967","unstructured":"Perret, A., Enrico, J. F., Montani, S., and Pappalardo, G. (1967)."},{"key":"ref_19","first-page":"533","article-title":"Intravascular coagulation in acute hepatic necrosis","volume":"1","author":"Rake, M.O.; Flute, P.T.; Pannell, G.; Williams, R.","year":"1970","unstructured":"Rake, M. O., Flute, P. T., Pannell, G., and Williams, R. (1970). Intravascular coagulation in acute hepatic necrosis. Lancet, 1, 533-537.","journal-title":"Lancet"},{"key":"ref_20","first-page":"165","article-title":"Diminished ketogenesis in liver injury","volume":"48","author":"Recant, L.","year":"1956","unstructured":"Recant, L. (1956). Diminished ketogenesis in liver injury. J. Lab. clin. Med., 48, 165-170.","journal-title":"J. Lab. clin. Med"},{"key":"ref_21","article-title":"Amino acid concentrations in fulminant hepatic failure and their role in the pathogenesis of hepatic coma","author":"Record, C.O.; Buxton, B.; Chase, R.; Curzon, G.; Williams, R.","year":"1974","unstructured":"Record, C. O., Buxton, B., Chase, R., Curzon, G., and Williams, R. (1974). Amino acid concentrations in fulminant hepatic failure and their role in the pathogenesis of hepatic coma. (Submitted for publication)."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"29","DOI":"10.3109\/00365516309051306","article-title":"Respiratory alkalosis and decreased oxygen saturation of arterial blood in patients with chronic hepatitis","volume":"15","author":"Reinicke, V.; Friis, T.; Mullertz, S.","year":"1963","unstructured":"Reinicke, V., Friis, T., and Mullertz, S. (1963). Respiratory alkalosis and decreased oxygen saturation of arterial blood in patients with chronic hepatitis. Scand. J. clin. Lab. Invest., 15, 29-36.","journal-title":"Scand. J. clin. Lab. Invest"},{"key":"ref_23","first-page":"131","article-title":"Les hepatites aigues comateuses: semiologie et 6volution. In Journees de Reanimation","author":"Rueff, B.; Sicot, C.; Benhamou, J.P.","year":"1969","unstructured":"Rueff, B., Sicot, C., and Benhamou, J. P. (1969). Les hepatites aigues comateuses: semiologie et 6volution. In Journees de Reanimation de l'H6pital Claude Bernard, Part I, pp. 131-143. Arnette, Paris."},{"key":"ref_24","article-title":"Non-Parametric Statistics for the Behavioral","author":"Siegel, S.","year":"1956","unstructured":"Siegel, S. (1956). Non-Parametric Statistics for the Behavioral"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1038\/ki.1972.43","article-title":"The generation and maintenance of metabolic alkalosis","volume":"1","author":"McGraw-Hill, Sciences; New York. Seldin, D.W.; Rector, Jr, F.C.","year":"1972","unstructured":"Sciences. McGraw-Hill, New York. Seldin, D. W., and Rector, F. C., Jr. (1972). The generation and maintenance of metabolic alkalosis. Kidney Int., 1, 306-321.","journal-title":"Kidney Int"},{"key":"ref_26","first-page":"661","article-title":"Blood ketoglutarate and pyruvate in liver disease","volume":"31","author":"Seligson, D.; McCormick, G.J.; Sborov, V.","year":"1952","unstructured":"Seligson, D., McCormick, G. J., and Sborov, V. (1952). Blood ketoglutarate and pyruvate in liver disease. J. clin. Invest., 31, 661.","journal-title":"J. clin. Invest"},{"key":"ref_27","article-title":"Les acidoses lactiques au cours des h6patopathies","author":"Smadja, M.; Opolon, P.; Hadchouel, P.; Touboul, J.P.; Caroli, J.","year":"1972","unstructured":"Smadja, M., Opolon, P., Hadchouel, P., Touboul, J. P., and Caroli, J. (1972). Les acidoses lactiques au cours des h6patopathies."},{"key":"ref_28","first-page":"450","article-title":"Statistical Methods","volume":"101","author":"Snedecor, G.W.; Cochran, W.G.","year":"1967","unstructured":"Snedecor, G. W., and Cochran, W. G. (1967). Statistical Methods, 6th ed. Iowa State University Press, Ames, Iowa. Tranquada, R. (1964). Lactic acidosis. Calif. Med., 101, 450-461.","edition":"6th ed","journal-title":"Lactic acidosis. Calif. Med"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1056\/NEJM196603032740901","article-title":"Treatment of hepatic coma by exchange blood transfusion","volume":"274","author":"Trey, C.; Burns, D.G.; Saunders, S.J.","year":"1966","unstructured":"Trey, C, Burns, D G., and Saunders, S. J. (1966). Treatment of hepatic coma by exchange blood transfusion. New Engl. J. Med., 274, 473-481.","journal-title":"New Engl. J. Med"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1016\/0304-4165(66)90194-2","article-title":"A role of phosphofructokinase on pH-dependent regulation of glycolysis","volume":"124","author":"Ui, M.","year":"1966","unstructured":"Ui, M. (1966). A role of phosphofructokinase on pH-dependent regulation of glycolysis. Biochim. biophys. Acta (Amst.), 124, 310-322.","journal-title":"Biochim. biophys. Acta (Amst.)"},{"key":"ref_31","article-title":"Respiratory alkalosis in hepatic coma","author":"Vanamee, P.; Poppell, J.W.; Glicksman, A.S.; Randall, H.T.; Roberts, K.E.","year":"1956","unstructured":"Vanamee, P., Poppell, J. W., Glicksman, A. S., Randall, H. T., and Roberts, K. E. (1956). Respiratory alkalosis in hepatic coma."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1016\/S0300-5089(21)00378-3","article-title":"Fulminant viral hepatitis","volume":"3","author":"Williams, R.","year":"1974","unstructured":"Williams, R. (1974). Fulminant viral hepatitis. Clin. Gastroent., 3, 419-436.","journal-title":"Clin. Gastroent"},{"key":"ref_33","first-page":"257","volume-title":"Metabolism and function of ketone bodies, In Essays in Cell Metabolism","author":"Williamson, D.H.","year":"1970","unstructured":"Williamson, D. H. (1970). Metabolism and function of ketone bodies, In Essays in Cell Metabolism, edited by W. Bartley, H. L. Kornberg, and J. R. Quayle, pp. 257-281."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1042\/bj0820090","article-title":"The determination of D(-)-3-hydroxybutyric acid and acetoacetic acid in blood","volume":"82","author":"Wiley, London; New York. Williamson, D.H.; Mellanby, J.; Krebs, H.A.","year":"1962","unstructured":"Wiley, London and New York. Williamson, D. H., Mellanby, J., and Krebs, H. A. (1962). The determination of D(-)-3-hydroxybutyric acid and acetoacetic acid in blood. Biochem. J., 82, 90-98.","journal-title":"Biochem. J"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"746","DOI":"10.1152\/jappl.1967.22.4.746","article-title":"Hyperlactatemia of hyperventilation","volume":"22","author":"Zborowska-Sluis, D.T.; Dossetor, J.B.","year":"1967","unstructured":"Zborowska-Sluis, D. T., and Dossetor, J. B. (1967). Hyperlactatemia of hyperventilation. J. appl. Physiol., 22, 746-755.","journal-title":"J. appl. Physiol"},{"key":"ref_36","doi-asserted-by":"crossref","DOI":"10.1001\/archinte.1966.00290150025007","article-title":"Pathogenesis of hepatic coma","volume":"118","author":"Zieve, L.","year":"1966","unstructured":"Zieve, L. (1966). Pathogenesis of hepatic coma. Arch. intern. Med., 118.","journal-title":"Arch. intern. Med"}],"container-title":["Gut"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/gut.16.2.144","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T08:32:32Z","timestamp":1765009952000},"score":1,"resource":{"primary":{"URL":"https:\/\/gut.bmj.com\/lookup\/doi\/10.1136\/gut.16.2.144"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1975,2]]},"references-count":36,"journal-issue":{"issue":"2","published-online":{"date-parts":[[1975,2,1]]},"published-print":{"date-parts":[[1975,2]]}},"alternative-id":["10.1136\/gut.16.2.144"],"URL":"https:\/\/doi.org\/10.1136\/gut.16.2.144","relation":{},"ISSN":["0017-5749","1468-3288"],"issn-type":[{"value":"0017-5749","type":"print"},{"value":"1468-3288","type":"electronic"}],"subject":[],"published":{"date-parts":[[1975,2]]}}}