Treatment of Cirrhosis of the Liver by a Nutritious Diet and Supplements Rich in Vitamin B Complex

Patek, Arthur J.; Post, Joseph

doi:10.1172/jci101242

Cited by 167 publications

(34 citation statements)

References 32 publications

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“…Nine cases were of the Laennec type; 1 (patient N.) was diagnosed as post-necrotic cirrhosis. The therapeutic regimen consisted, in general, of the nutritious diet and supplements rich in vitamin B complex described by Patek and Post (12). 145 Colloid osmotic pressure For the determination of colloid osmotic pressure an Hepp osmometer (13) was used.…”

Section: Methodsmentioning

confidence: 99%

Osmotic Factors Influencing the Formation of Ascites in Patients With Cirrhosis of the Liver

Mankin¹,

Lowell²

1948

J. Clin. Invest.

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According to present concepts, the ascites that occurs in patients with cirrhosis of the liver is formed by transudation from the plasma into the peritoneal cavity through the walls of the capillaries of the portal system. A ready explanation for this transudation has been at hand, based upon the hypothesis originally proposed by Starling (1 to 3) that interchange of fluid between blood and tissue spaces is controlled by the balance between capillary blood pressure and osmotic pressure of plasma proteins. In patients with cirrhosis and ascites the portal venous pressure is high (4); the serum albumin concentration (5 to 7) and the serum colloid osmotic pressure (8) are low. The observations of Post and Patek (7) have suggested that the presence or absence of ascites in patients with cirrhosis of the liver is determined chiefly by the serum albumin level.Recent observations have thrown doubt upon this concept (9, 10). In the course of an investigation of the effects of intravenous injection of concentrated human serum albumin in patients with cirrhosis and ascites (10) it was observed that elevation of the colloid osmotic pressure of the plasma to normal levels for periods of 2 weeks did not decrease the rate of ascites formation. There occurred instead a marked increase in the rate of diffusion of albumin from the plasma into the ascitic fluid and a rise in the colloid osmotic pressure of the ascitic fluid which paralleled that of the plasma.Because these observations seemed inconsistent with the accepted concepts of the mechanism of ascites formation, the present studies were undertaken in order (a) to determine whether or not the formation of ascites in patients with cirrhosis of the liver is controlled by osmotic factors, in accordance with the Starling hypothesis, and (b) to evaluate the role of the diffusion of plasma proteins into the peritoneal cavity.According to the Starling hypothesis, the flow of fluid across the portal capillary membrane is controlled by the balance of hydrostatic and colloid osmotic pressures on both sides of the membrane (11), such that at equilibrium: portal capillary pressure minus intra-abdominal hydrostatic pressure = plasma colloid osmotic pressure minus ascitic colloid osmotic pressure.Disturbance of the osmotic balance by alteration of any of these factors should produce corresponding changes in the rate and direction of flow.In order to test the validity of this hypothesis, direct measurements were made of (1) the plasma colloid osmotic pressure, (2) ascitic colloid osmotic pressure, (3) the intra-abdominal hydrostatic pressure, and (4) the ascitic fluid volume, both in the unmodified course of the formation and loss of ascites, and after experimental alteration of one of the osmotic factors. The experimental elevation of plasma colloid osmotic pressure was effected by (a) mercupurin diuresis and (b) intravenous injection of concentrated human serum albumin. Plasma colloid osmotic pressure was decreased by the oral administration of physiological saline solution. Ascitic co...

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Section: Methodsmentioning

confidence: 99%

Osmotic Factors Influencing the Formation of Ascites in Patients With Cirrhosis of the Liver

Mankin¹,

Lowell²

1948

J. Clin. Invest.

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“…Although fatty cirrhosis can be produced in animals by means of low protein diets and prevented by methionine or choline, Eckhardt and his coworkers (7), in a previous study from this laboratory, observed that dramatic improvement in clinical status and hepatic function without significant decrease in hepatic fat occurred in three chronic alcoholics with fatty cirrhosis studied when they were maintained on a diet containing essentially no protein. Their diet did contain, however, an estimated 30 to 100 mg. of choline and one vitamin capsule 6 per day.…”

Section: Discussionmentioning

confidence: 99%

“…In support of this view is the association of fatty cirrhosis with states of malnutrition unaccompanied by alcoholism (3,4). Moreover, the apparent therapeutic efficacy of a nutritious diet, as reported by Patek and Post (5,6), further suggests nutritional deficiency as an etiologic factor. But whether the success of this regimen resides in the diet, withdrawal of alcohol, bed rest, or in a combination of these factors, is as yet unsettled.…”

mentioning

confidence: 92%

Comparative Effects of a Purified and an Adequate Diet on the Course of Fatty Cirrhosis in the Alcoholic 1

Phillips¹,

Gabuzda²,

Davidson³

1952

J. Clin. Invest.

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“…The effect of albumin administration on the excretion of sodium (Table II, Figure 6) Prompt diuresis with rapid loss of both edema and ascites is seen in a few patients with cirrhosis of the liver following the intravenous administra- 9 The administration of hypertonic salt solution intravenously in normal individuals stimulates the release of an antidiuretic substance from the pituitary and diminishes urine flow for short periods of time (17). However, the administration of saline in hypo-, iso-, or hypertonic concentrations in normally hydrated individuals, allowed free access of water, results in a considerably increased excretion of water if the urine collections are made over longer periods of time, as in the present study (18).…”

Section: Methodsmentioning

confidence: 99%

“…Although the serum albumin concentration may by this means be raised to normal, the edema and ascites have not been consistently relieved (4)(5)(6)(7). Moreover, improvement in ascites and edema is observed in some instances with mercurial diuretics or simply by furnishing a nutritious diet alone (8,9). In an attempt to find an abnormality common to these patients and consistently altered by the apparently unrelated therapeutic agents, the studies of sodium excretion and balance reported here were undertaken.…”

mentioning

confidence: 99%

The Effect of Human Serum Albumin, Mercurial Diuretics, and a Low Sodium Diet on Sodium Excretion in Patients With Cirrhosis of the Liver 123

Faloon¹,

Eckhardt²,

Cooper³

et al. 1949

J. Clin. Invest.

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Treatment of Cirrhosis of the Liver by a Nutritious Diet and Supplements Rich in Vitamin B Complex

Cited by 167 publications

References 32 publications

Osmotic Factors Influencing the Formation of Ascites in Patients With Cirrhosis of the Liver

Osmotic Factors Influencing the Formation of Ascites in Patients With Cirrhosis of the Liver

Comparative Effects of a Purified and an Adequate Diet on the Course of Fatty Cirrhosis in the Alcoholic 1

The Effect of Human Serum Albumin, Mercurial Diuretics, and a Low Sodium Diet on Sodium Excretion in Patients With Cirrhosis of the Liver 123

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