Abstract
The effect of phenobarbital upon bile secretion, serum bile acids, serum bilirubin,drug metabolizing activity, and hepatic ultrastructure was systematically evaluated in three children with chronic cholestatic conditions. In a patient with paucity of intrahepatic bile ducts, the following were observed in relation to the administration of phenobarbital: (1) decrease in pruritus and jaundice, (2) an increase in biliary secretion, (3) doubling of rose bengal clearance, (4) liver biopsies demonstrating a marked diminution in the size and frequency of bile plugs in the bile canaliculi, and (5) a decrease in plasma half-life of diphenylhydantoin from 12 to 4 hours. A proliferation of smooth endoplasmic reticulum was present in the hepatic cell ultrastructure. Salicylamide, clofibrate, and cholestyramine did not alter serum bilirubin or bile acid levels. These data suggest that phenobarbital administration may evoke an increase in bile secretion in selected patients with chronic cholestatic conditions.
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