The Serum Trihydroxy-Dihydroxy Bile Acid Ratio in Liver and Biliary Tract Disease1

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Abstract
A method for the simultaneous differential quantitation of serum trihydroxy and dihydroxy bile acids employs extraction with alcohol containing a Ba(OH)2-Ba(C2H3O2)2 buffer followed by hydrolysis and quantitation in 65% H2SO4 at 320 m[mu] and 380 m[mu] with a Beckman spectrophotometer. Normal values are, trihydroxy acids, 1.4 /xg/ml, and dihydroxy acids 0.8 [mu]g/ml. Patients with intrahepatic or extrahepatic obstructive jaundice have increased serum bile acid concentrations but the trihydroxy-dihydroxy ratio remains greater than one, whereas jaundiced patients with severe liver injury have trihydroxy-dihydroxy ratios of less than one. The method has proven useful in determining extent of liver injury and prognosis.