Splanchnic metabolism of fuel substrates in acute liver failure

Background/Aims: This study aimed to characterize the exchange of fuel subs trates in the splanchnic circulation in acute liver failure. Methods: Liver vein catheterization was used in 22 patients with acute live r failure after development of hepatic encephalopathy grade III-IV. Healthy controls, patients with cirrhosis and patients with acute on chronic liver disease were also studied. Results: In acute liver failure there was splanchnic removal of glucose (0. 21+/-0.44 mmol/min), release of lactate (0.34+/-0.37 mmol/min), pyruvate (0 .08+/-0.06 mmol/min) and ketone bodies (0.04+/-0.02 mmol/min), while extrac tion of amino acids and free fatty acids was insignificant. In the acute li ver failure group, a normal hepatic venous oxygen saturation (0.69+/-0.12) and normal pyruvate/lactate ratio suggested absence of hypoxia even though the acetoacetate/beta -hydroxybutyrate ratio was decreased. Only in the acu te liver failure group did the measured splanchnic oxygen content differenc e exceed what could be accounted for even by hypothesizing complete oxidati on of all extracted blood-borne fuel substrates; oxidation of endogenous su bstrates may be quantitatively important in this condition. Conclusion: Acute liver failure was associated with a state of accelerated glycolysis in the splanchnic region, leading to release of lactate in the a bsence of splanchnic hypoxia.