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METABOLISM OF CHOLIC ACID ‐ 24‐14C IN PATIENTS WITH HEPATOBILIARY DISEASES

Cholic acid‐24‐14C was injected i.v. into five patients with chronic liver disease (four with Laennec's cirrhosis and one with amyloidosis) and three patients with acute liver failure of different etiology (massive hepatic necrosis of unknown etiology, carbon tetrachloride liver injury, infectious hepatitis). The rate of disappearance of isotope from the blood during the first 60 min was depressed in patients with icterus. An anicteric patient with amyloidosis showed greatly depressed removal rate. Only trace amounts of isotope were excreted in urine during the first hours following injection and only a small fraction of the cholic acid pool was eliminated by urinary excretion, since less than 13% of the administered isotope was excreted in urine during the four days following injection. Similar studies were performed in two patients with interrupted enterohepatic circulation of bile acids due to calculi in the choledochus. Bile was sampled through a T‐tube inserted in the choledochus. These patients had impaired liver function, as indicated by bilirubin concentration above 6.0 mg/100 ml. The injected isotope was rapidly excreted in bile and all isotope was recovered in bile within 24 hours in conjugated form. Chromatographic analysis of urinary labelled metabolites showed that eight of the ten patients mainly excreted labelled conjugated bile acids. In two of the patients, one with Laennec's cirrhosis and one with hepatic necrosis, a constant excretion of 30–40% of unconjugated labelled bile acids was observed.