Serum cholinesterase in analbuminemia.

S EVERAL SUGGESTIONS have been made to explain the parallelism between serum cholinesterase and serum albuniin levels in chronic liver disease-first recognized by Faber (i), and since, by many othersand the moderate fall in serum cholinesterase found to occur ill normal persons after the infusion of albumin (2). Kunkel and Ward (3) suggested that a normal serum albumin level was needed for the synthesis of cholinesterase to proceed normally. Vorhaus and Kark (2) concluded that there was an intimate relationship between the biosyntheses of both proteins. An obvious test of these explanations is offered by analbulnillemia. Bennhold et at. (4) mention in passing that their first patient with analbuminemia had a nonmal serum cholinesterase level. We have had the opportunity to measure serum cholinesterase activity in 2 additional patients with this hereditary disorder, and we also find tile levels to be normal. In J. L., the patient described by Shetlar et al. (5) and by Waldmann e al. (6), the serum specimen was drawn when the alh’imin concentration was less than 0.1 gm./100 ml. by paper electrophoresis (5), although at other times values as high as 0.3 gm./100 ml. were noted (6). In G. M., the patient described by Gordon et al. (7) and by Bartter et at. (8), the serum sample was drawn after treatment with intravenous albumin, when the distribution of serum protenh4 was normal by paper electrophoresis. The results of serum cholinesterase determinations are shown in Table 1. Both samples had normal eholinestorase activity with acetyl-