Hepatic tolerance to hypotension as assessed by the changes in arterial ketone body ratio in the state of brain death.

Hepatic tolerance to hypotension was assessed by changes in arterial ketone body ratio (KBR) and hepatic energy charge levels in experimental brain death induced by epidural ballooning in dogs, and compared with the hemorrhagic shock model. Systolic arterial blood pressure was significantly decreased from 182 mmHg to 67 mmHg after completion of brain death (P less than 0.01), but KBR was maintained at near the control value of 1.098 +/- 0.051 in spite of marked hypotension. Hepatic energy charge was 0.846 +/- 0.016 and remained at normal level. No significant changes were observed in lactate level, total bilirubin, SGPT, and LDH. SGOT was slightly elevated but was still within normal limits (P less than 0.05). Light microscopic examination revealed no apparent ischemic change in the centrilobular region under hematoxylin and eosin staining. By contrast, KBR decreased from 0.975 +/- 0.054 to 0.273 +/- 0.060 following hypotension in the Wiggers' shock model (P less than 0.01). Lactate levels were gradually elevated significantly (P less than 0.05), but no significant increases were observed in total bilirubin, SGOT, SGPT, and LDH. It is suggested that the hepatic energy status is well maintained in the state of brain death, in which state the liver has high tolerance to marked hypotension until shortly before stoppage of the heart.