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Eric Niederhoffer SIU-SOM

A 38-year-old woman is brought to the physician because of frequent falls, increasing confusion, and incontinence. How does ethanol ingestion cause nutrition problems?. Eric Niederhoffer SIU-SOM. Ketone body processing overview Ketogenesis and ketone body utilization Clinical features.

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Eric Niederhoffer SIU-SOM

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  1. A 38-year-old woman is brought to the physician because of frequent falls, increasing confusion, and incontinence How does ethanol ingestion cause nutrition problems? Eric Niederhoffer SIU-SOM

  2. Ketone body processing overview Ketogenesis and ketone body utilization Clinical features Alcoholic Ketoacidosis

  3. Energy for the Brain and Nerves Epinephrine Norepinephrine HSL ketogenesis Albumin AT β-oxidation Ketone Body Processing Overview TAG Ketone Bodies FA adipose tissue Thr Phe liver Leu Tyr Ile Trp αKA Lys muscle

  4. β-oxidation TCA Ile, Thr AA CoA thiolase AACoAT Lys, Trp Suc HMG CoA synthase SCoA Leu 3KACoAT HMG CoA lyase Tyr, Phe NADH NADH NAD+ NAD+ 3HBDH 3HBDH AA 3HB Acetone neuron mitochondrion Ketogenesis and Ketone Body Utilization TAG Generates lots of ATP hepatocyte mitochondrion Acetyl CoA Acetyl CoA AACoA AACoA HMGCoA AA 3HB

  5. History (Typical symptoms reflect poor nutritional status from long-term alcohol abuse) poor nutrition volume depletion ketone bodies buildup Nausea, vomiting, and abdominal pain (each found in 60-75% of patients) Dyspnea, tremulousness, and/or dizziness (10-20% each) Muscle pain, diarrhea, syncope, and seizure (1-8% each) Physical examination Tachycardia, tachypnea, and/or abdominal tenderness (30-40% each) Hypotension, hypothermia, fever, abdominal distention, rebound tenderness, hepatomegaly, ascites, and/or heme-positive stools (1-15% each.) Clinical Features (H&P)

  6. Arterial blood gas Look for MAC, may have mixed acid-base disorder (MAC from ketone formation, MAL from vomiting/volume depletion, RAL secondary to hyperventilation) Serum ketones Order specific test of 3HB (3HB/AA > 5) Glucose and electrolytes Low, normal, or high Glc (in DKA, Glc high) Elevated anion gap Elevated lactate Elevated BUN and creatinine Complete blood count Looking for anemia, intravascular volume depletion Liver and pancreatic function tests Total bilirubin, ALT, AST, LDH, AP, PA, PL Alcohol levels Patient may have decreased drinking; generally does not change approach Clinical Features (Laboratory Studies)

  7. What are ketone bodies? Which amino acids are ketogenic? How are ketone bodies generated (substrates, enzymes, pathways, location)? How are ketone bodies metabolized (enzymes, pathways, location)? What is the effect of NADH levels on ketone bodies? How does the metabolism of ketone bodies correlate with clinical findings? Review Questions

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