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.
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?
(Typical symptoms reflect poor nutritional status from long-term alcohol abuse)
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)
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)
Look for MAC, may have mixed acid-base disorder (MAC from ketone formation, MAL from vomiting/volume depletion, RAL secondary to hyperventilation)
Order specific test of 3HB (3HB/AA > 5)
Glucose and electrolytes
Low, normal, or high Glc (in DKA, Glc high)
Elevated anion gap
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
Patient may have decreased drinking; generally does not change approachClinical Features (Laboratory Studies)
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