Studies on the disturbance of glucuronide formation in infectious hepatitis.

The ability of the liver to form glucuronides was measured in 10 patients with infectious hepatitis. One test was done at the onset and another about four weeks later after the clinical symptoms had disappeared. N-acetyl-p-aminophenol (N.A.P.A.) or acetanilide was administered in doses ranging from 10 to 20 mg. per kg. body weight, either orally or by intravenous injection. N.A.P.A. is conjugated by the liver at the hydroxyl group and excreted in the urine as sulphuric and glucuronic acid conjugates. Total conjugated p-aminophenol, free N.A.P.A., and N.A.P.A. glucuronide were estimated in the urine of our patients. In the blood the disappearance of N.A.P.A. (free form) and the formation of N.A.P.A. glucuronide were traced. During the acute phase of hepatitis the excretion of total conjugated p-aminophenol and of N.A.P.A. glucuronide in the urine is lower than after recovery from the disease. Likewise free N.A.P.A. disappears more slowly from the circulation and the peak concentration of N.A.P.A. glucuronide in the serum remains lower at the onset of hepatitis than after clinical cure. These results indicate that glucuronide formation during the acute stage of infectious hepatitis is depressed, as are other transformation mechanisms, i.e., of hippuric acid.