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The data submitted in this presentation indicate that the amount of benzoic acid excreted in the urine as hippuric acid in the Quick intravenous test (1) for liver function is influenced to a considerable extent by the volume of the simultaneous output of urine. This factor may account for some of the high values that at times have been observed in normal individuals, and even in patients with hepatic disease. The data also show a lack of correlation between body weight, bromsulphalein excretion, and the results of the Quick test. Before Quick (2) introduced the hippuric acid test for liver function, it had been employed by Kingsbury and Swanson (3) and by Bryan (4) as a measure of renal function. Thus, for the proper interpretation of the test in liver disease, it would seem that adequate renal function should be present, because an impairment of the latter would depress the rate of excretion of the hippuric acid and so mimic hepatic dysfunction. Accordingly some workers have regarded, as a prerequisite for the proper interpretation of the test in hepatic disease, normal renal function, as judged by the urea clearance test or by the absence of a retention of blood urea nitrogen. Quick (5) believed, however, that the rate of hippuric acid excretion by the kidneys is 50 per cent higher than its rate of synthesis in the liver and that, as a result, only very serious disorders of renal function would affect its elimination in the urine. Thus it has been alleged that a normal excretion of hippuric acid can be obtained despite a greatly diminished urea clearance or an increased urea content of the blood (6, 7). The effect of the volume of the output of the urine on the amount of hippuric acid eliminated 1 Presented before the American Federation for Clinical Research, April 20, 1942, Minneapolis, Minn. 2 Aided by a grant from the Smith, Kline and French Laboratories. has received little attention, though Snapper and Grunbaum (8) noted that nephritic patients, having an abnormal retention of urea, may eliminate more hippuric acid in a large than in a small output of urine. Probstein and Londe (7), on the other hand, found no relation between urinary volume and the output of hippuric acid in 14 normal subjects. A small excretion of hippuric acid, together with a small volume of urine, was observed in certain subjects in whom all other tests of hepatic function were negative. At first, this was thought to be due to incomplete evacuation of the bladder, but a similar result was obtained when we resorted to catheterization. Then, a very high value for hippuric acid excretion was observed in a patient who had a decompensated portal cirrhosis. He passed at the same time a very large volume of urine. He had a blood urea nitrogen concentration of 5 mgm. per cent, and it seemed probable that, in him, a simple diuresis was occurring. On the basis of these observations, we decided to determine whether or not any significant correlation could be established between the amount of the hippuric acid excreted and the simultaneous volume of the urine in our series of cases in which hippuric acid tests were being done. Because Mateer (9) suggested that the size of the individual might influence the results of the test, we also examined for a.correlation between body weight and the amount of hippuric acid excreted in the urine. Wehave included, in addition, data on the results of the bromsulphalein test because a difference of opinion (9 to 12) exists in the literature concerning the relative sensitivity of the bromsulphalein and the hippuric acid tests.

THE RELATION OF HIPPURIC ACID EXCRETION TO THE VOLUME OF THE URINE 12