Determination of digitalis-like substances in sera of patients with acute hepatic failure and its clinical significance, with special reference to middle molecular substances.:with special reference to middle molecular substances

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Endogenous digitalis-like substances (DLS) have inhibitory activity on Na+ K+-ATPase as well as cross-immunoreaction with anti-digoxin antibodies. The present study was conducted to investigate the clinical significance of DLS in patients with acute hepatic failure (AHF). Serum levels of DLS increased significantly in patients with AHF as compared with those with acute hepatits and acute hepatitis (severe type). These levels were elevated in parallel with the increasing severity of acute liver diseases. These levels were found to be particularly higher in patients with brain edema than in those without brain edema. Since the serum levels of DLS showed significant negative correlations with prothrombin time and the integrated CT number of the whole liver, and positive correlations with plasma levels of methionine and aromatic amino acids, it is conceivable that DLS levels change in accordance with the degree of hepatic failure. Partial purification of DLS from the plasma of patients with AHF showed that DLS appeared in several different fractions on gel chromatography, and were also co-chromatographed with middle molecular weight substances which inhibit rat brain microsomal Na+ K+-ATPase activity. In conclusion, these results suggest that the determination of serum DLS is important to predict the development of fatal complications of AHF, particularly that of brain edema.
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