Pathophysiology of hemorrhagic shock. A role of arterial ketone body ratio as an index of anoxic metabolism of the liver in acute blood loss.

The changes in the oxido-reduction state and the adenylate energy charge of the liver were investigated in rats having 16%, 50%, and 84% mortality rates after acute hemorrhage. In the arterial blood, concentrations of ketone bodies, pyruvate, lactate, and the ratios (acetoacetate to beta-hydroxybutyrate and pyruvate to lactate) were measured after hemorrhage and reinfusion of the shed blood. The mitochondrial oxido-reduction state and the blood ketone body ratio decreased 15 minutes after hemorrhage. The values of these parameters of rats having the higher mortality rate were lower than those rats having the lower mortality rate. In addition, the changes in both the adenylate energy charge and the mitochondria oxido-reduction state of the liver were closely correlated with the changes in the ratio of acetoacetate to beta-hydroxybutyrate in the arterial blood (P less than 0.001). Thus, it is suggested that the decreased oxygen supply to the liver mitochondria may play an important role in determining the mortality rate after acute hemorrhage and is reflected in the ratio of acetoacetate to beta-hydroxybutyrate in the arterial blood.