Hepatic and extrahepatic elimination of ethanol in cirrhosis. With estimates of intrahepatic shunts and Km for ethanol elimination.

In eight patients with cirrhosis of the liver the hepatic and the extrahepatic ethanol elimination rate (EER) were studied by steady-state infusion during hepatic venous catheterization. EER measured by single injection overestimated total body EER by 15%. Hepatic and extrahepatic EER were significantly decreased to about two thirds in cirrhosis and were correlated to other variables indicating the severity of the disease. Differences in EER, however, diminish considerably when corrected for body weight, for reasons that are poorly understood. A maximal value of intrahepatic shunted blood could be calculated to 15% (3-38%) of hepatic blood flow. It was correlated to the transsinusoidal pressure gradient (r = 0.91). A rough estimate of the apparent Michaelis constant (Km) of hepatic and extrahepatic EER was in the range of 0.1--0.3 mmol x 1(-1). Forty percent of ethanol elimination occurred outside the liver. The large extrahepatic EER may be important in the development of extrahepatic organ injuries.