Studies on Bile Pigment Part 2. On the Glucnronic Acid Metabolism in the Urine of Various Biliary

Using the urine obtained from four cases of mechanical jaundice, one case of acute hapatitis, and one case of chronic hepatitis, (cholangiolitis) to the total of six cases and isolating ester-type direct bilirubins by Sakamoto's ion-exchange chromatography, the author studied the bilirubin glucuronide distribution as against the fractions of the entire ester-type bilirubins; and obtained the following restlts. 1. When the distribution of bilirubin giucuronide is calculated on the basis of the quantitative determination of glucuronic acid: a) The minimum value of bilirubin glucuronide to the entire ester-type bilirubin was zero per cent, the maximum 30-60 per cent, and the average 16-32 per cent. b) As to the variation by different diseases it was impossible to determine definitely as the number of the cases studied was small. c) In the case with normal liver function or with a minimal disturbance of the liver, the minimum value was 12.5-25 per cent; the maximum 30-60 per cent; and the average value was 17-38 per cent. In the case with advanced liver disorder the minimum value was zero per cent; the maximum 10.5-21 per cent; and the average 5.5-11 per cent. 2. When the bilirubin glucuronide distribution is calculated from the indirect bilirubin content produced after hydrolysis by alkali: a) The minimum value is zero per cent; the maximum 38 per cent; and the average was 21 per cent. b) In the case with normal liver function or with a minimal disorder of the liver the minimum value was 13 per cent; the maximum 38 per cent; and the average value 24 per cent; while in the case with far advanced disorder of the liver the minimum was zero per cent; the maximum 17 per cent; and the average 9 per cent. 3. From these findnings it can be assumed that the direct bilirubins in the jaundice urine, with exception of basic direct bilirubin, belong mostly to what we call the ester-type direct bilirubin in our laboratory, while on the contrary the quantity of bilirubin glucuronide can be found only in a small percentage, and in the case of far advanced disorder of the liver it is sometimes extremely reduced and even disappears completely when compared with the quantity of the so-called ester-type direct bilirubin.