The role of vitamin C deficiency in chronic alcoholism

Gastric erosions caused by home-brewed lager. A 22 year old male was admitted to hospital because of melaena due to acute gastric erosions. In the three weeks prior to his admission, he had drunk several gallons of home-brewed lager. Investigations revealed that this was contaminated with acetaldehyde and acetic acid which had been produced by an acetobacter organism present in the yeast. Experiments were carried out on the effect of home-brewed lager and beer on the stomachs of the guinea pigs. The incidence of erosive gastritis was significantly increased when the animals were given similarly contaminated home-brewed lager. This observation is of importance since the home-brewing of beer and lager has become common since its legalisation in 1964. A clinical study was carried out to determine the leucocyte ascorbic acid levels and the iron status of fifty alcoholics admitted to medical and psychiatric wards. In addition, the dietary intake of vitamin C and iron was estimated. The age range of the group was 24-70 years and this included nine females, age range years. None of the patients had overt liver disease and none were intoxicated at the time the blood sample was taken. All the alcoholic patients had an inadequate intake of iron (15 mg/day) but the haemoglobin, erythrocyte protoporphyrin and serum iron levels showed, that over 55% of the patients showed no signs of anaemia. In the absence of liver disease, the incidence of anaemia in alcoholics was lower than expected. L.A.A. was estimated by the 2,4-dinitrophenyl method and the average daily intake of vitamin C was calculated from the diet history. The alcoholic group was matched with a normal group of patients according to age. (within five years) and sex. The results show that, as a group, alcoholics are sub-clinically scorbutic. Their vitamin C levels, 18.8 +/- 11.01 (mean +/- S.D,) mug/108 WBC are significantly lower (p 0.0005) than those of the matched group, 27.41 +/- 7.59 (mean +/- S.D.) mug/108 WBC. The L.A.A. levels in different age groups are not significantly different from each other but in every age group the alcoholic group has a significantly lower vitamin C level when compared with the control group. When the diet histories were studied, it was clear that the main reason for low L.A.A. levels was inadequate intake of vitamin C. Having established that alcoholics are generally deficient in vitamin C, an investigation was carried out to ascertain if this condition could directly affect the metabolism of ethanol. An experiment was designed to measure the induction of hepatic alcohol dehydrogenase by alcohol in sub-clinically scorbutic guinea pigs. However, the criteria of sub-clinical scurvy (i.e. a state where there is a diminished level of ascorbic acid in the body without apparent manifestations of scurvy) had to be established at the outset. The leucocyte ascorbic acid levels and the vitamin C levels in the liver, stomach and upper small intestine of guinea pigs were measured by the usual 2,4 dinitrophenyl hydrazine method. These levels show that guinea, pigs are sub-clinically scorbutic after two weeks on a scorbutic diet. Only male guinea pigs were used in the experiments. The levels of ADH were measured in the guinea pig livers after daily injections of 2 ml of 30% ethanol in saline for two days, one week, two weeks and three weeks. The guinea pigs in the scorbutic groups were always maintained on the scorbutic diet for two weeks. The results show that ADH is maximally induced within two days and that there is a highly significant increase in ADH levels in sub-clinically scorbutic guinea pigs fed ethanol. The potentiation of ADH induction in sub-clinically scorbutic states could explain the increased tolerance of alcoholics for alcohol since sub-clinical scurvy was present in the majority of the cases of chronic alcoholism. The level of NAD was measured in guinea pigs injected with 30% alcohol for two weeks and fed the scorbutic diet. The levels of NAD are higher in sub-clinically scorbutic animals fed ethanol than in normal animals fed ethanol

The effects of prolonged hepatic ischaemia before 70 per cent partial hepatectomy in the dog

The effect of prolonged normothermic ischaemia before partial hepatectomy was assessed in 10 dogs. During the period of ischaemia, portal decompression was maintained. The survival rate for animals undergoing 75 minutes of total liver ischaemia was 60 per cent, and 2 of the dogs died as a result of hypoglycaemia. High levels of alkaline phosphatase and transaminases in the survivors indicated a severe degree of hepatocyte damage. However, complete restoration of liver mass was noted 6 weeks after partial hepatectomy and was not impaired by the prolonged ischaemia. This study confirms the resistance of the dog liver to ischaemia before partial hepatectomy. The critical period beyond which ischaemia is followed by an increasing number of deaths and severe metabolic upset is in the region of 1 hour