Metabolic Changes in Active Chronic Hepatitis

1. The metabolic and hormonal responses to intravenous glucose (0·5 g/kg body wt.) were studied in ten normal subjects and thirteen patients with active chronic hepatitis. Untreated patients showed a decreased initial insulin response and glucose intolerance (KG, 0·89 ± 0·10%/min compared with 2·34 ± 0·24%/min), together with a paradoxical rise in growth hormone. 2. Fasting blood lactate and pyruvate were normal but both metabolites showed a diminished rise after glucose. The rate of rise of lactate was directly related to initial insulin secretion in both hepatitis subjects and controls. 3. Fasting blood ketone bodies, blood glycerol, plasma triglycerides and free fatty acids were all significantly elevated in the patient group. Results were similar to those found in mild diabetes mellitus. 4. In two patients with a more severe cirrhosis fasting values of serum insulin, growth hormone, blood lactate, pyruvate and glycerol were raised. 5. After corticosteroid therapy hyperinsulinism was found together with a return towards normal of glucose tolerance (KG, 1·49 + 0·10%/min), ketone bodies, free fatty acids and triglycerides; blood glycerol remained elevated and lactate response to glucose was excessive. 6. It is suggested that in active chronic hepatitis there might be pancreatic dysfunction on an autoimmune basis.