Water-soluble vitamins in severe liver disease.

SUMMARY ·Biochemical deficiency of thiamine, vitamin B6, ascorbic acid or nicotinic acid occurred in 71% and 88% of patients with fulminant hepatic failure (FHF) and decompensated chronic liver disease (DCLD) respectively. Transient high plasma vitamin B6 concentrations in FHF were followed by low levels later in the illness. Although patients with DCLD of alcoholic aetiology tended to have lower circu­ lating levels of vitamins than those with non-alcoholic DCLD, the prevalence of abnormally low concentrations did not differ. Decreased dietary nutrient intake and alcohol appeared to be less important determinants of biochemical vitamin deficiency than the presence of liver disease per se. Finally, urinary excretion of these vitamins or their major metabolites in patients with severe liver disease cor­ related poorly with circulating levels of vitamins. S. AIr. med. l., 54, 183 (1978). Increased circulating water-soluble vitamin levels have been noted during the acute phase of human viral hepa­ titis,' and thi~ has also been reported in rats with CCl,­ induced hepatic necrosis.' Low hepatic vitamin concen­ trations in the rats were' in favour of release of vitamins from necrotic hepatocytes as an explanation for the hypervitaminaemia. By contrast, low blood concentrations of vitamins have been found in chronic liver diseases such as alcoholic cirrhosis, 'chronic viral hepatitis' and biliary cirrhosis.' Patients with alcoholic cirrhosis com­ monly had deficiencies of water-soluble vitamins, while in those with primary biliary cirrhosis, fat-soluble vitamins were more often affected. In the patients with alcoholic liver disease, vitamin defici~ncy is usually ascribed to dietary inadequacies plus additional factors such as the gastritis and anorexia produced by excess alcohol intake, maldigestion due to alcohol-induced pancreatic disease,' impaired absorption of thiamine: decreased hepatic uptake or storage of folate,' malutilization of thiamine; increased requirements of folate', vitamin B", thiamine, niacin and riboflavin' and increased urinary losses of folic acid, vitamins B" and