CLINICAL VALUE OF THE TEST FOR HIPPURIC ACID IN CASES OF DISEASE OF THE LIVER

Abstract

A satisfactory test of the function of the liver should (1) detect and estimate hepatic insufficiency, (2) aid in a differential diagnosis, (3) have prognostic usefulness and (4) contribute toward a better understanding of the physiology of the liver. With these objectives, the synthesis of hippuric acid: (benzoic acid + amino-acetic acid = hippuric acid) was studied both experimentally and clinically.1 It was observed that the hourly rate of excretion of hippuric acid in normal persons following the ingestion of sodium benzoate is remarkably constant, being influenced only somewhat by the size of the subject or, more exactly, by the surface area. In certain types of disease of the liver, however, the output of hippuric acid is markedly reduced. This reduction is due primarily to the diminished capacity of the liver to synthesize amino-acetic acid and in part to damage of the enzymatic mechanism which unites benzoic acid with amino-acetic acid. In