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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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Presentation Transcript
slide1

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

alcoholic ketoacidosis
Ketone body processing overview

Ketogenesis and ketone body utilization

Clinical features

Alcoholic Ketoacidosis
ketone body processing overview

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

ketogenesis and ketone body utilization

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

clinical features h p
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)
clinical features laboratory studies
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)
review questions
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