An evaluation of factors influencing the discriminative effectiveness of a group of liver function tests. IV. Nature of the interrelationships among hepatic tests in cirrhosis.
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Safety of intravenous (i.v.) or intrapulmonary administration of different concentrations of honey and their effects on blood sugar, renal and liver function tests, bone marrow function, lipid profile, and carbon tetrachloride (CCl(4))-induced liver damage were studied. Healthy sheep of either sex, 6-8 months old, were assigned randomly into the following groups: sheep received i.v. infusion of 5% honey in normal saline at 10-day intervals for 50 days and were compared with sheep that received 5% dextrose; sheep received higher doses of honey (50 g of honey) by i.v. infusion daily for 10 days; sheep received four higher doses of honey (80 g each dose) for 2 weeks; sheep received subcutaneous injection of CCl(4) after four doses of i.v. infusion of 80 g of honey, and estimations of serum gamma-glutamyl transpeptidase (SGGT), serum glutamic oxaloacetic transaminase (SGOT), and serum glutamate pyruvate transaminase (SGPT) were performed daily for 10 days postinjection; sheep received i.v. infusion of 40 g of honey, and blood sugar estimation was performed for 3 h at 30-min intervals after infusion and compared with sheep that received 5% dextrose; sheep received rapid i.v. injection of 40% honey or 40% dextrose, and blood sugar was estimated before and after injection; sheep received various concentrations of honey in distilled water (0.5 mL/1.5 mL, 0.75 mL/1.75 mL and 1.2 mL/2.2 mL), and blood sugar estimation was performed before and after inhalation. Results showed that i.v. or intrapulmonary administration of honey did not cause any adverse effect. Intravenous delivery of honey by slow infusion caused improvement of renal and hepatic function, bone marrow function, and lipid profile. It reduced SGOT, SGPT, triglyceride, cholesterol, blood urea nitrogen, and blood sugar and elevated serum protein, serum albumin, hemoglobin, white blood cell, and neutrophil percentage. Similar results were obtained with the use of higher doses of honey. CCl(4) caused mild elevation of SGPT and SGGT and lowering of SGOT in sheep that received repeated i.v. administration of honey before administration of CCl(4), whereas in control sheep CCl(4) caused significant elevation of all the liver enzymes. Intravenous infusion of 40 g of honey caused elevation of blood sugar for 90 min postinfusion, whereas it decreased blood sugar at 2 and 3 h postinfusion as compared with fasting blood sugar. Dextrose caused significant elevation of blood sugar at all time intervals. Similar results were obtained with the use of 10% dextrose or 80 g of honey. Addition of honey to dextrose caused less hyperglycemia as compared with dextrose alone. Acute injection of 20 mL of 40% dextrose significantly elevated blood sugar for 3 h postinjection, whereas little elevation in blood sugar was obtained after injection of 40% honey; the difference between honey and dextrose was significant. Inhalation of honey caused significant lowering of blood sugar during and after inhalation as compared with fasting blood sugar and water inhalation. The effect was greater with a higher concentration of inhaled honey. It might be concluded that slow i.v. infusion or rapid i.v. injection of honey in different concentrations was safe and could lower blood sugar and improve renal, hepatic, and bone marrow functions and lipid profile. Intravenous honey had a hepatoprotective effect against CCl(4)-induced liver injury. Inhaled honey was safe and reduced blood sugar significantly.
Liver function abnormalities are often found on routine chemical profiles. Abnormal test results are often false positive in asymptomatic patients. Repeat testing and confirmation that the liver is the source of the abnormality are the first steps of evaluation. A thorough history and physical examination may suggest reasons for the abnormalities. If no etiology for the abnormal test result is found, further testing is indicated.
Liver injury has long been associated with occupational exposure to a wide variety of chemicals. The controversial data existing in relation to hepatotoxicity of organic solvents might be explained as a consequence of the different exposures or it may well be that the tests used for evaluating liver function might not be sensitive enough to detect any mild changes at an early stage. To study liver function during exposure to solvent mixtures, we determined serum bile acid (SBA) concentrations as compared with conventional liver function tests in a selected group of workers (n = 30) occupationally exposed to a mixture of organic solvents (mostly toluene, xylene, acetone, n-butylacetate, n-butanol, ethylacetate) and in a reference group (n = 20). The mean levels of liver enzyme activities and bilirubin concentrations in the two groups were similar, whereas mean SBA levels increased in the exposed group (8.0 +/- 6.0 mumol/l vs 2.8 +/- 1.4 mumol/l) and the difference as compared with the controls was significant (P less than 0.01). In 73% of the exposed workers, SBA levels were higher than 5.6 mumol/l (the cut-off value) as compared with 5% of the controls. These results demonstrate the higher sensitivity in detecting liver dysfunction achieved with the SBA test as compared with conventional hepatic function tests. As increased SBA concentrations are considered to reflect an impairment of anion transport across the liver, higher SBA levels in the group of workers exposed to organic solvents might be explained as a slight and early sign of liver dysfunction. Therefore, SBA determination in biological monitoring of workers exposed to potentially hepatotoxic chemicals might be proposed.
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