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Table 2: Acid-base alterations and liver function before and after of cardiac surgery. |
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Patient |
Initial diagnosis |
Cardiac surgery |
Drugs during the surgery |
Laboratories |
Acid-Base disorder |
Postoperative liver injury (ALT/AST > 5 LSN) |
Ringer’s lactate solution dose (ml/h/day) |
Clinical outcome |
|
|
Preoperative |
Postoperative |
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|
1 |
Infective endocarditis (aortic valve) |
AVR (mechanical) |
Vasopressin Norepinephrine Levosimendan Dobutamine Midazolam Fentanyl Fast insulin |
Lactate ↕ pH ↕ pCO2 ↕ HCO3− ↓ ALT ↑ AST ↕ LDH ↑ |
Lactate ↑ pH ↓ pCO2 ↓ HCO3− ↓ ALT ↑* 4 AST ↑ LDH ↑ |
Metabolic and/or mixed acidosis |
Hepatocellular (ALT ↑) |
100 ml/h/1 day 60 ml/h/1 day 40 ml/h/2 days 10 ml/h/2 days |
Improvement |
|
2 |
Mixed aortic valve disease |
AVR and MVR (mechanical) |
Vasopressin Norepinephrine Levosimendan Dobutamine Fentanyl Midazolam FAST insulin Dexmedetomidine |
Lactate ↕ pH ↕ pCO2 ↕ HCO3− ↕ ALT ↕ AST ↕ LDH ↓ |
Lactate ↑ pH ↓ pCO2 ↓ HCO3− ↓ ALT ↑ AST ↑ LDH ↑ |
Metabolic and/or mixed acidosis |
Hepatocellular (ALT ↑) |
100 ml/h/4 days 5 ml/h/1 day |
Acute liver failure |
|
3 |
Mitral regurgitation |
MVR (biological) |
Norepinephrine Dobutamine Levosimendan Furosemide Fentanyl Midazolam |
Lactate ↕ pH ↕ pCO2 ↕ HCO3− ↕ ALT ↕ AST ↕ LDH ↕ |
Lactate ↑ pH ↕ pCO2 ↕ HCO3− ↓ High NA AST ↑ LDH ↑ |
Metabolic and/or mixed acidosis |
Hepatocellular (ALT ↑) |
60 ml/h/2 days |
Cardiogenic shock |
|
4 |
Tetralogy of Fallot |
Correction with bovine pericardial patch |
Norepinephrine Fentanyl Vasopressin Midazolam Amiodarone |
Lactate ↕ pH ↓ pCO2 ↕ HCO3− ↕ ALT ↕ AST ↕ LDH ↕ |
Lactate ↑ pH ↓ pCO2 ↓ HCO3− ↓ High NA AST ↑ LDH ↑ |
Metabolic and/or mixed acidosis |
Hepatocellular (ALT ↑) |
100 ml/h/1 day |
Cardiogenic shock |
|
5 |
Mitral stenosis |
MVR (mechanical) |
Vasopressin Norepinephrine Levosimendan Fentanyl Midazolam Milrinone |
Lactate ↕ pH ↓ pCO2 ↕ HCO3− ↕ ALT ↕ AST ↕ LDH ↕ |
Lactate ↑ pH ↓ pCO2 ↓ HCO3− ↓ ALT ↑ AST ↑ LDH ↑ |
Metabolic acidosis |
Hepatocellular (ALT ↑) |
100 ml/h/1 day 50 ml/h/2 days |
Acute liver failure |
|
6 |
Acute aortic dissection (Stanford A) |
Replacement of supracoronary aorta and aortic arch |
Vasopressin Levosimendan Norepinephrine Dobutamine Fentanyl Midazolam |
Lactate ↕ pH ↕ pCO2 ↓ HCO3− ↓ ALT ↕ AST ↕ LDH ↕ |
Lactate ↑ pH ↓ pCO2 ↑ HCO3− ↓ High NA AST ↑ LDH ↑ |
Metabolic acidosis |
Hepatocellular (ALT ↑) |
100 ml/h/1 day |
Cardiogenic shock |
|
7 |
Acute aortic dissection (Stanford A) |
Bentall-De Bono procedure |
Vasopressin Norepinephrine Levosimendan Morphine Dobutamine Fentanyl Midazolam |
Lactate ↕ pH ↕ pCO2 ↓ HCO3− ↕ ALT ↑ AST ↕ LDH × 1.1 |
Lactate ↑ pH ↓ pCO2 ↕ HCO3− ↓ ALT ↑ AST ↑ LDH ↑ |
Metabolic acidosis |
Hepatocellular (AST ↑) |
60 ml/h/1 day 100 ml/h/1 day |
Septic shock (AKI and AHF) |
|
8 |
Mixed aortic valve disease and mitral regurgitation |
AVR and MVR (biological) |
Vasopressin Norepinephrine Levosimendan Dobutamine Fentanyl Midazolam |
Lactate ↕ pH ↕ pCO2 ↕ HCO3− ↕ ALT ↓ AST ↕ LDH ↕ |
Lactate ↑ pH ↕ pCO2 ↕ HCO3− ↓ ALT ↑ AST ↑ LDH ↑ |
Metabolic acidosis |
Hepatocellular (AST ↑) |
100 ml/h/1 day 50 ml/h/2 days |
Septic shock (AKI and AHF) |
|
9 |
Aortic prosthetic dysfunction |
AVR (mechanical) |
Vasopressin Norepinephrine Dobutamine Fentanyl Milrinone Morphine |
Lactate ↕ pH ↕ pCO2 ↓ HCO3− ↓ High NA AST ↕ LDH ↑ |
Lactate ↑ pH ↓ pCO2 ↑ HCO3− ↓ High NA AST ↑ LDH ↑ |
Metabolic and/or mixed acidosis |
None |
100 ml/h/1 day 30 ml/h/1 day 10 ml/h/5 days |
Improvement |
|
10 |
Myocardial infarction |
Coronary artery bypass grafting |
Vasopressin Norepinephrine Dobutamine Fentanyl Midazolam |
Lactate ↕ pH ↕ pCO2 ↓ HCO3− ↕ ALT ↕ AST ↕ LDH ↕ |
Lactate ↑ pH ↓ pCO2 ↕ HCO3− ↓ ALT ↑ AST ↑ LDH ↑ |
Metabolic acidosis |
Hepatocellular (ALT ↑) |
300 ml/h/1 day 60 ml/h/1 day 10 ml/h/1 day 0 ml/h/4 days 80 ml/h/1 day 40 ml/h/1 day |
Septic shock and multi-organ failure |
|
11 |
Acute aortic dissection (Stanford B) |
Bentall-De Bono procedure |
Vasopressin Norepinephrine Levosimendan Fentanyl Midazolam FAST insulin |
Lactate ↑ pH ↕ pCO2 ↕ HCO3− ↕ ALT ↕ AST ↕ LDH ↕ |
Lactate ↑ pH ↓ pCO2 ↕ HCO3− ↓ ALT ↑ AST ↑ LDH ↑ |
Metabolic acidosis |
Hepatocellular (AST ↑) |
100 ml/h/1 day 200 ml/h/2 days 20 ml/h/7 days |
Improvement |
|
12 |
Chronic pulmonary thromboembolism |
Bilateral pulmonary thromboendarterectomy |
Vasopressin Norepinephrine Levosimendan Dopamine Dexmedetomidine Dobutamine Fentanyl |
Lactate ↕ pH ↕ pCO2 ↕ HCO3− ↕ ALT ↕ AST ↕ LDH ↕ |
Lactate ↑ pH ↓ pCO2 ↕ HCO3− ↓ ALT ↑ AST ↑ LDH ↑ |
Metabolic acidosis |
Hepatocellular (AST ↑) |
100 ml/h/1 day 40 ml/h/1 day |
Improvement |
|
↑ = Increased by 1 normal upper limit. ↓ = decreased by 1 normal upper limit. ↕ = normal values. AHF = acute hepatic failure. AKI = acute kidney injury. ALT = alanine aminotransferase. AST = aspartate aminotransferase. AVR = aortic valve replacement. LDH = lactate dehydrogenase. MVR = mitral valve replacement. pCO2 = partial pressure of carbon dioxide. |
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