PLASMA-EXCHANGE AND THE ARTERIAL BLOOD KETONE-BODY RATIO IN PATIENTS WITH ACUTE HEPATIC-FAILURE

Hepatocyte regeneration in acute hepatic failure is essential for reco very, but requires a large amount of energy. One problem with plasma e xchange as supportive therapy in these cases is that massive citrate i nfusion has an adverse effect on the hepatic energy charge, which may be a serious risk in these patients. The ratio of acetoacetate to beta -hydroxybutyrate in arterial blood has been reported to reflect the ce llular energy charge of hepatocytes. In this study, this ratio was ass essed before and after plasma exchange in 19 patients with acute hepat ic failure. Eight patients recovered and 11 died. The arterial blood k etone body ratio was below 0.6 in all II nonsurvivors. It fell to belo w 0.4 in 10 of them during the first plasma exchange session, and rema ined below 0.4 for over 12 h in seven of them. On the other hand, the arterial blood ketone body ratio returned to above 0.6 in four of eigh t surviving patients within 12 h after the first plasma exchange and r emained below 0.4 for over 12 h only in two of eight patients. These d ata indicate that plasma exchange may cause suppression of the arteria l ketone body ratio in patients with severe acute hepatic failure. The se metabolic changes impair liter metabolism and may make effective he patocyte regeneration impossible. (C) Journal of Hepatology.