Excretion of Keto Acids and Hydroxyphenyl Compounds in Pernicious Anemia

Abstract

It has been found in this laboratory that the urinary excretion values for keto acids of patients with untreated pernicious anemia in relapse show a marked decrease when liver extract is administered by intramuscular injection. Since there are several indications that tyrosine metabolism may be disturbed in pernicious anemia, it was of interest to measure the urinary hydroxyphenyl compounds in this disease in order to determine whether or not their excretion values could be correlated with those of the keto acids. Previous experiments by Becher 1 have shown a rise in blood phenols in pernicious anemia and, in contrast, Volterra 2 observed a low excretion of volatile phenols in the urine in untreated pernicious anemia and a greatly increased excretion of these compounds after liver therapy.

Twenty-four-hour urine sample were collected in acid and analyzed for keto acids by the method of Penrose and Quastel 3 and for hydroxyphenyl compounds by the Medes modification of the method of Folin and Ciocalteu. 4 Analyses were made on 4 patients with pernicious anemia before and after liver therapy and, for comparison, on 10 patients receiving the same hospital diet who were apparently healthy except for traumatic injuries.

The analyses on the comparison group gave for urinary keto acids expressed as pyruivic acid, ranging from 73 to 100 mg per 24 hours with an average of 82 mg. For urinary hydroxyphenyl compounds expressed as tyrosine, the values range form 150 to 230 mg per 24 hours with an average of 95 mg.

The data for the pernicious anemia cases are shown in Table I. At least 4 twenty-fourhour collection specimens were employed in determining the average and range values.

These results indicate that patients with untreated pernicious anemia have an increased excretion of keto acids and hydroxyphenyl compounds, but that after therapy the excretion levels are similar to those of healthy individuals.