Plasma Fatty Acids after Adrenalin Injection in Normal Subjects and in Patients with Liver Disease: Prognostic Significance.

During the past few years contradictory reports have appeared in the literature concerning the behavior of plasma fatty acids after the injection of adrenalin. Himwich and his collaborators (1, 2, 3) claimed to have demonstrated a sharp rise in plasma fatty acids after the subcutaneous injection of adrenalin in dogs and after emotional stimulation. Koskoff and Dusser de Barenne (4) have reported similar findings after stimulation of the central end of the sciatic nerve. Rony and Ching (5), and Bornstein and Muller (6) on the contrary failed to find significant changes in plasma fatty acids after the injection of adrenalin in dogs. Actual decreases in the plasma fatty acids following the injection of adrenalin in dogs have been reported by Alpern and Collazza (7), Raab (8), and Alpern and Tutkewitsch (9). Finally Long and Venning (10) claim to have been unable to produce any change in plasma fatty acids after perfusion experiments with adrenalin on anesthetized cats and criticise the results obtained by Himwich and his coworkers as being due to faulty methods of determining fatty acids. According to Long and Venning the methods of Stewart and White (11) modified by Himwich, Friedman, and Spiers (12) are of no value for the estimation of fatty acids, owing to the fact that during saponification of alcohol-ether extracts of plasma, the glucose breaks down to organic acids which may be titrated as " fatty acids." A second source of error lies in the inclusion as " fatty acids " of the phosphoric acid liberated by hydrolysis of the phospholipids. Apparent increases in fatty acids, as determined by the above methods, were obtained by them after the addition of known amounts of glucose to samples of blood plasma. The above authors also noted that the addition of glucose to blood plasma produced no change in " fatty acids " when the latter were determined according to the method of Stoddard and Drury (13). In this method after saponification of the plasma extract the fatty acids are precipitated with an excess of HCl, filtered off, thoroughly washed with a 5 per cent solution of NaCl, dissolved in hot alcohol and titrated. By this method all organic acids except the fatty acids are removed before the final titration. During a study of the blood lipids in cases of liver disease we have made use of the method of Stoddard and Drury1 and in order to reassure ourselves as to the accuracy of this method known amounts of glucose, lactic acid, cystine and phosphoric acid have been added to samples of whole blood, the fatty acid content of which had been determined previously by the above method. The results are in accord with those of Long and Venning. No changes were noted after the addition of these substances beyond the limits of error of the method and the results are given in Table I.