Case study answers

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Case study answers

Published November 5, By Dr. Namrata Chhabra A 35 —year-old woman became severely depressed after the sudden death of her husband. She appeared thin and pale. Questioning revealed that she had not eaten for several weeks.

Her recovery was uneventful. How was the patient obtaining energy during the time when she was not eating? Why is BUN elevated? It is a case of starvation.

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The high blood Alanine level signifies the catabolic state. Alanine in excess is released during starvation from muscle to serve as a substrate for glucose production in liver. High BUN signifies protein degradation; the carbon skeletons of amino acids are utilized for glucose production while amino groups are converted to urea.

In the absence of food the plasma levels of glucose, amino acids and triacylglycerols fall, triggering a decline in insulin secretion and an increase in glucagon release. This sets in to motion an exchange of substrates between liver,adipose tissue, muscle and brain that is guided by two priorities i the need to maintain glucose level to sustain the energy metabolism of brain ,red blood cells and other glucose requiring cells and Case study answers to supply energy to other tissues by mobilizing fatty acids from adipose tissues and converting them to ketone bodies to supply energy to other cells of the body.

Fuel Stores A typical well-nourished kg man has fuel reserves totaling aboutkcalkJ.

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The energy need for a hour period ranges from about kcal kJ to kcal 25, kJdepending on the extent of activity. Thus, stored fuels suffice to meet caloric needs in starvation for 1 to 3 months. However, the carbohydrate reserves are exhausted in only a day. The first priority of metabolism in starvation is to provide sufficient glucose to the brain and other tissues such as red blood cells that are absolutely dependent on this fuel.

However, precursors of glucose are not abundant. Most energy is stored in the fatty acyl moieties of triacylglycerols.

Fatty acids cannot be converted into glucose, because acetyl CoA cannot be transformed into pyruvate. The glycerol moiety of triacylglycerol can be converted into glucose, but only a limited amount is available.

The only other potential source of glucose is amino acids derived from the breakdown of proteins. However, proteins are not stored,and so any breakdown will necessitate a loss of function. It is a biological compromise to provide glucose to these cells as a priority.

Glucagon stimulates the mobilization of triacylglycerols in adipose tissue and gluconeogenesis in the liver.

Case study answers

The liver obtains energy for its own needs by oxidizing fatty acids released from adipose tissue. The concentrations of acetyl Co A and citrate consequently increase, which switch off glycolysis. Thus glucose utilization is stopped in liver cells to preserve glucose for priority cells Energy need of muscles The uptake of glucose by muscle is markedly diminished because of the low insulin level, whereas fatty acids enter freely.

Consequently, muscle shifts almost entirely from glucose to fatty acids for fuel. The alanine, lactate and much of the keto-acids resulting from this transamination are exported from muscle, and taken up by the liver, where the alanine is transaminated to yield pyruvate.

Pyruvate is a major substrate for gluconeogenesis in the liver. This leads to release from adipose tissue of increased amounts of glycerol which is a substrate for gluconeogenesis in the liver and free fatty acids,which are used by liver, heart, and skeletal muscle as their preferred metabolic fuel, therefore sparing glucose.

Loss of muscle mass During starvation, degraded proteins are not replenished and serve as carbon sources for glucose synthesis.

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Initial sources of protein are those that turn over rapidly, such as proteins of the intestinal epithelium and the secretions of the pancreas.

Proteolysis of muscle protein provides some of three-carbon precursors of glucose. The nitrogen part of the amino acids is converted to urea BUN c Ketosis Energy need of peripheral tissues After about 3 days of starvation, the liver forms large amounts of acetoacetate and beta- hydroxybutyrate.

Gluconeogenesis depletes the supply of oxaloacetate, which is essential for the entry of acetyl CoA into the citric acid cycle.Search over , Bible questions, answers, and notes. If you have a question on a verse, look up that verse to find answers.

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