Rate of Excretion of a Large Dose of Penicillin
Authors: L. P. Garrod, R. A. Shooter
Journal: BMJ (1950)

MEDBCRLJOURNsL 1169 at the time of discharge was smaller.The circumstances are the same with regard to urobilinuria, except that at discharge a slightly greater number of cases were positive in the M. series.Hay's test for bile acids showed a slight TABLE I1.-Results of Test for Bile Products and Their Derivatives in the Urine C. Series M. Series Reactionl No. of No. of No. of No. of Cases Weeks Cases Weeks Hammarsten: Neg.whole time in hospital .. .. 31 42 Pos.-neg.while in hospital .. 85 1-7 77 1 6 Pos.whole time in hospital .. 9 6 Schlesinger: Neg.whole time in hospital .. 12 24 Pos.-. neg.while in hospital .. 71 2-6 53 2-3 Pos.whole time in hospital .. 42 48 Neg.whole time in hospital .. .16 18 Pos.-* neg.while in hospital .. 99 1 9 912-0 Pos.whole time in hospital .. 16 tendency to the contrary, with a somewhat longer positive reaction in the M. series.There were no significant statistical differences in the urine reactions.The length of stay in hospital in the control cases was 27.5 ± 1.4 days and in the methionine cases 25.0 ± 1.4 days.The essential facts obtained from these tests are that the cases treated with methionine tend to show a smaller increase in bile pigments in the blood and a quicker return to normal values, and consequently that the secretion of bile pigments and urobilin in the urine also ceases earlier.But, compared with the untreated cases, the difference is very small, and statistically is not significant.Definite effects cannot therefore be claimed for treatment by this method.If, however, methionine treatment had been given during the whole course of the illness the results might probably have been better ; but this is problematical.While these attempts to treat acute hepatitis with methionine have not been very encouraging, I certainly think that amino-acids should be used in the treatment of pre-comatose and comatose cases.Though I am unable to present a scientific basis for this op'nion, our experience tends to show that a course of amino-acids given intra- venously is of value in severe cases. SummaryIn experiments on animals several investigators have proved that the amino-acid methionine affords excellent protection to the liver against damage caused both by toxins and by lack of protein in the diet.Attempts to use methionine in the treat- ment of acute hepatitis have been made by several authors, with contradictory results.Methionine treatment was given in 125 slight and semi-severe cases of acute hepatitis and an equal number served as control cases.The group treated with methionine showed fewer cases with increasing bilirubinaemia after admission to hospital, a slightly smaller increase in bilirubinaemia, and. a somewhat quicker return to normal values, as well as an earlier cessation of secretion of bilirubin and urobilin in the urine as compared with the cases not receiving treatment.Thymol reaction and secretion of bile acids showed a more uncertain tendency.The prothrombin index decreased slightly more in the untreated cases.The differences, however, were small and were not proved statistically.The investigation shows that a marked effect is scarcely to be expected from the use of methionine in the treatment of acute hepatitis of average severity.In more severe cases of hepatitis, however, clinical experience suggests that amino-acids may be of value when given intravenously.