Background:13CO2 is decreased in patients with end-stage liver disease by the [1-13C]-phenylalanine breath test. Decreased 13CO2 is supposed to be caused by the decreased ability of the liver to oxidize phenylalanine. However, no direct evidence has been reported. Methods: The [1-13C]-phenylalanine breath test was performed in galactosamine hepatitis rats (n = 14) and control rats (n = 8). Plasma phenylalanine concentration before intravenous administration of [1-13C]-phenylalanine, the elimination rate of phenylalanine and the phenylalanine hydroxylase (PAH; EC 1.14.16.1) activity of the whole liver were examined. Results: Increase of 13CO2 in the breath [Δ13CO2 (‰)] of galactosamine hepatitis rats 2 min after administration of [1-13C]-phenylalanine was only 1/5 of that in control rats. The concentration of plasma phenylalanine and the elimination rate of plasma phenylalanine in hepatitis rats did not show significant differences compared to control rats. On the other hand, a clear difference in the activity of PAH was observed between hepatitis rats and control rats. Δ13CO2 (‰) 2 min after administration of [1-13C]-phenylalanine was highly correlated to the PAH activity of the whole liver (r = 0.917). Conclusion: It was strongly indicated that decreased Δ13CO2 in hepatitis rats was the result of decreased activity of PAH.