A STUDY OF PYRUVIC ACID IN THE BLOOD AND SPINAL FLUID OF PATIENTS WITH LIVER DISEASE WITH AND WITHOUT HEPATIC COMA 1

Abstract

To investigate the possibility of impaired intermediary carbohydrate metabolism in hepatic failure, pyruvic acid was determined by the modified Lu method in blood, spinal fluid, and urine. Controls included 16 surgical patients with mechanical disability and 31 patients with various diseases exclusive of liver disease. Thirty-six patients with liver disease included 12 with viral hepatitis and 24 with portal cirrhosis. Fourteen were observed in hepatic coma (9 cirrhosis, 5 hepatitis). Pyruvic acid levels in the hepatitis group (excluding those in coma) were normal. The group with simple decompensated cirrhosis had moderately elevated values on admission which returned to normal within a few days. The highest values were found in hepatic coma, in which group the pyruvic acid was constantly elevated. Serial detns. showed an abrupt rise during coma and a decline with improvement. Spinal fluid values were elevated in 10 and normal in 4. Mean blood, urine (mg.%) and spinal fluid values in the coma group were significantly higher than values in the cirrhosis group without coma and in the control group. A series of patients with pulmonary emphysema (arterial oxygen saturation of 51.1-93.3%) gave normal blood and urine values. This would exclude hypoxia (reported to occur in cirrhosis) as a cause of elevated values. The degree of elevation of blood pyruvic acid would appear to depend upon the degree of hepatic failure. This may result from an inability of the liver to assimilate pyruvic acid to form the dicarboxylic acids necessary for the Kreb''s cycle. Thus failure of cellular aerobic metabolism may well explain the neurological manifestations and oliguria so characteristic of hepatic coma.