The presence of glucagon in ascitic fluid in cirrhotic patients

Abstract

Glucose, insulin, glucagon, and liver profiles were determined simultaneously in plasma and ascitic fluid after an overnight fast in ten cirrhotic patients to assess the role of ascites in hyperglucagonemia and hyperinsulinemia of hepatic cirrhosis and to investigate if glucagon and insulin diffuse freely across the peritoneum. Plasma in ten normal subjects was studied as well. Glucose levels in plasma were normal in all patients; in ascitic fluid they were higher than in plasma in 7 cases and lower in 3 cases. Plasma glucagon was raised in seven patients with advanced liver dysfunction as documented by the presence of jaundice and reversed albumin/ globulin ratio. Plasma insulin was elevated in patients with hepatic dysfunction and/or esophageal varices. In the absence of jaundice and varices, glucagon and insulin concentrations were normal. Ascitic fluid glucagon was always lower than the plasma with a significant correlation. Ascitic fluid insulin was undetectable in three patients. In the remaining patients, the realtionship between plasma and ascitic fluid insulin levels was not significant. No relationship were observed between liver dysfunction and hormonal concentrations in ascitic fluid. These studies suggest that, (1) both glucagon.and insulin may diffuse freely across the peritoneum into the peritoneal cavity, with a consistent glucagon gradient between plasma and ascitic fluid. The apparent lack of such a relationship for insulin is unexplained and may need further evaluation, and (2) in hepatic cirrhosis the presence of ascites may not influence plasma glucagon or insulin concentrations unless accompanied by jaundice and a reversal of albumin/globulin ratio, both indices of advanced liver dysfunction and the presence of esophageal varices, a sign of moderately severe portosystemic shunting.