Serum and urinary methionine concentrations in severe hepatic failure of viral hepatitis. Relevance to development of encephalopathy and prognosis.

A simple spectrophotometric method was developed to measure serum and urinary methionine concentrations. Serum methionine concentrations of greater than 200 mumol/L were found only in patients who were suffering from severe liver failure. In patients who died because of severe liver failure, a continuing increase in the methionine concentration was associated with a deteriorating mental state, while in patients who recovered the serum methionine concentration remained below 200 mumol/L during the coma stage. Urinary methionine to creatinine ratios above 300 were found only in specimens from patients who died. Sera and urine specimens from patients who were suffering from uncomplicated viral hepatitis showed no increase in methionine concentrations, while sera from patients with renal impairment and urinary specimens from patients who were suffering from chronic active hepatitis showed normal or only mildly elevated methionine concentrations.