الفهرس 
Lactate and glucose metabolism and normal acid base balanceOnly 14 pages are availabe for public view
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Abstract
The liver is the key organ in regulating metabolism. The Liver plays a major role in regulating lactate level and lactate metabolism. Lactic acid is generated by the Glycolytic pathway and Deamination of amino acids with multiple factors leading to lactic acidosis. It is metabolised in the liver and entering it by two pathways, Semi specific monocarboxylate transporter and Simple diffusion of un-ionized lactic acid. Also, the liver is the major determinant of glucose level which is received through diet or synthetized endogenously. Acid base balance is one of the main roles undertaken by the liver through Deamination-oxidation of amino acids and Urea and glutamine handling. Moreover, Electrolytes; such as sodium, potassium and calcium are affected in liver disease to a great extent.
Anesthetic and surgical considerations of LT operation must be well known to the anesthetists. Anesthetic considerations includes preoperative assessment of the most common health problems facing the transplant candidate such as ascites, SBP, renal failure and the most dramatic emergence of malignancy. Anesthetist must be familiar with these complications management. While intraoperatively, monitoring of transplant recipient may be very meticulous, requiring monitoring of blood, electrolytes, coagulation, temperature (whether central or peripheral temperature), cardiac output (CO) and CNS monitoring. Surgical technics in LT vary; their effect on anesthesia may be fatal.
Lactate eventually will lead to lactic acidosis, 2 types are defined type A associated with tissue hypoxia while type B not. Lactate is expected to rise during liver transplantation and its treatment includes specific alkali therapy (soduimbicarb and carbicarb) and dichloroacitate. Glucose disturbances are very common in liver patients and have to be taken care of any symptoms and signs preoperatively and managed seriously intra-operatively and post-operatively. Acid base is largely affected in liver disease; metabolic acidosis is, by far, the most important acid base disorder in liver patients. Electrolyte imbalance (hyponatremia, hyper and hypokalemia and hypocalcemia) carries a great concern for the anesthetic and in the ICU management.