| PRS 0409-766 Lipschitz
Lipschitz AH, Kenkel JM, Luby M, Sorokin E, Rohrich RJ, Brown SA.
Electrolyte and plasma enzyme analyses during large-volume liposuction.
Plast Reconstr Surg. 2004 Sep 1;114(3):766-75; discussion 776-7. PMID: 15318060
Department of Plastic Surgery, Nancy Lee and Perry R. Bass Advanced Plastic
Surgery and Wound Healing Laboratory, Dallas, Texas, USA.
Substantial fluid shifts occur during liposuction as wetting solution is
infiltrated subcutaneously and fat is evacuated, causing potential electrolyte
imbalances. In the porcine model for large-volume liposuction, plasma aspartate
aminotransferase and alanine transaminase levels were elevated following
liposuction. These results raised concerns for possible mechanical injury and/or
lidocaine-induced hepatocellular toxicity in a clinical setting. The first
objective of this human model study was to explore the effect of the liposuction
procedure on electrolyte balance. The second objective was to determine whether
elevated plasma aminotransferase levels were observed subsequent to large-volume
liposuction. Five female volunteers underwent three-stage, ultrasound-assisted
liposuction. Blood samples were collected perioperatively. Plasma levels of
sodium, potassium, venous carbon dioxide, blood urea nitrogen, chloride, and
creatinine were determined. Liver function analyte levels were measured,
including albumin, total protein, aspartate aminotransferase, and alanine
transaminase, alkaline phosphatase, gamma-glutamyl transpeptidase, and total
bilirubin. To further define intracellular enzyme release, creatine kinase
levels were measured. Mild hyponatremia was evident postoperatively (134 to 136
mmol/liter) in four patients. Hypokalemia was evident intraoperatively in all
subjects (mean +/- SEM; 3.3 +/- 0.16 mmol/liter; range, 3.0 to 3.4 mmol/liter).
Hypoalbuminemia and hypoproteinemia were observed throughout the study
(baseline: 2.9 +/- 0.2 g/dl; range, 2.6 to 3.5 g/dl), decreasing to 10 to 40
percent 24 hours postoperatively (2.0 +/- 0.2 g/dl; range, 1.7 to 2.1 g/dl).
Aspartate aminotransferase, alanine transaminase, and creatine kinase levels
were significantly elevated after the procedure (190 +/- 47.1 U/liter, 50 +/-
7.7 U/liter, and 11,219 +/- 2556.7 U/liter, respectively) (p < 0.01).Release of
antidiuretic hormone and even mildly hypotonic intravenous fluid infiltration
have long been known to cause hyponatremia postoperatively. Intraoperative
hypokalemia is associated with hypocarbia and respiratory alkalosis and the
elevated epinephrine levels observed in the concurrent study. Factors having the
greatest initial impact on diminished serum albumin and protein levels
postoperatively are redistribution and hemodilution. Subsequent diminished
viscosity may significantly affect postoperative hemodynamics. Elevated
aspartate aminotransferase, alanine transaminase, and creatine kinase levels are
associated with skeletal muscle injury, adipocyte lysis, and/or hepatic damage.
Therefore, tissue injury is associated with large-volume liposuction as observed
in several cellularly released enzymes. Future clinical studies are required to
determine the degree of injury and specific tissues that are damaged or
sensitive to mechanical trauma and/or drugs used in large-volume liposuction.
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