SPLANCHNIC METABOLISM ASSOCIATED WITH LIVER METASTASIS

Metastatic liver disease can modify the metabolic response to critical illness. Systemic lactic acidosis may arise from an increased product ion due to inadequate peripheral tissue oxygen transport, altered meta bolic function such as depressed pyruvate oxidation or insufficient he patic clearing capacity due to tumor replacement of functional liver m ass. Hepatic venous catheterization in a patient with extensive metast atic melanoma to the liver and adult respiratory distress syndrome ind icated a marked disparity between whole body and liver oxygenation whi ch may arise due to a markedly stepped up splanchnic oxygen utilizatio n unmatched by a proportionate rise in regional oxygen delivery. Since some neoplasms may exhibit increased metabolic activity, it is suspec ted that these metastatic lesions may have contributed to the observed regional hypermetabolism thereby worsening hepatic hypoxia and exacer bating lactic acidosis. This case also illustrates the difficulties in interpreting global indicators of metabolic function and oxygenation in critically ill patients.