J.Jpn. Surg. Soc.. 83(1): 88-95, 1982

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Original article

CHANGES IN ARTERIAL BLOOD KETONE BODY RATIO AFTER HEPATIC RESECTION-A CLUE TO EVALUATE THE ENERGY STATUS OF THE REMNANT LIVER

As previously reported, the decrease in hepatic energy charge level is the fundamental feature of hepatic dysfunction after major hepatic resection. In the present study, the postoperative changes in the arterial blood ketone body ratio (acetoacetate/β-hydroxybutyrate), reflecting the NAD^＋-NADH redox state of liver mitochondria, were measured in 20 patients with hepatic resection in comparison with other liver function tests. In oder to exclude the fasting effect on the blood ketone body ratio, blood samples were taken in the presence of sufficient glucose supply.
The patients were classified into 3 groups according to the postoperative changes in the blood ketone body ratio. (A) In 8 patients, the blood ketone body ratio did not decrease to below 0.7. (B) In 7 patients, the blood ketone body ratio decreased transiently to 0.4-0.7 and then increased to over 0.7. (C) Five patients showed irreversible decreases in the blood ketone body ratio. The degree of decrease in this parameter was more closely related to operative mortality and morbidity rates than conventional blood analyses.
Therefore, the arterial blood ketone body ratio appears to be a reliable indicator of the critical decrease in hepatic energy charge level after hepatic resection. Careful metabolic supports will be possible through the serial measurement of the blood ketone body ratio.

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