THE METABOLISM OF FOLIC ACID IN CIRRHOSIS

Abstract

Four of 16 patients with macrocytic anemia associated with hepatic cirrhosis and chronic alcoholism exhibited megaloblastic bone marrows. The 4 possessed normal serum vitamin B12 levels, but manifested a deficiency of folic acid in their subnormal daily urinary excretion of folic acid and of citrovorum factor, in their failure to excrete administered folic acid promptly, and in their striking clinical and hematologic responses to small daily doses of folic acid. The remaining 12 patients had [image]normo-blastic[image] bone marrows, showed normal urinary levels of folic acid, and failed to respond to either synthetic folic acid or citrovorum factor. The dietary histories and alcoholic consumption of the cirrhotic patients with megaloblastic marrows were not significantly different from those of the group as a whole, and no abnormalities were apparent in these patients in their responsiveness to or in the absorption, deconjugation or renal excretion of folic acid. It is possible that an increased requirement for folic acid, compounded in most cases with marginal or inadequate dietary intakes, accounts for the apparent susceptibility of patients with chronic alcoholism and cirrhosis to the development of folic acid deficiency.