Question

Metabolic Case Study

IM Desperate is an 18-year-old college freshman who was brought to the emergency room by her roommates. She was pale, dizzy and extremely weak. Her friends told the following story: IM was 140 lbs and 5’3” at the beginning of the school year. She did not do well socially the first month on campus so decided she would lose weight to become more popular. She stopped eating anything except water, coffee, and 2 multivitamins per day. After several days she became listless and stopped attending classes. She collapsed while taking a shower on the eighth day and was rushed to the emergency room. Her physical exam showed acetone on her breath and blood glucose of 60.

16. What is the current state of IM’s nitrogen balance?

17. What is her body using as a glucose source since she is in the late fasting state?

18. Why does she have acetone on her breath? Explain how this symptom develops during fasting.

Answer 1

16) Since the patient is in late fasting state, there is negative nitrogen balance in her body. Her body excretes more nitrogen than it takes in.

This is the current state of patient's nitrogen balance.

17) Since the patient is in late fasting state, her body utilizes both fats and proteins as a glucose source for energy.

18) Patient have acetone on her breath because her body is in the state of ketosis. As a result of this acetone is produced in her body due to lack of carbohydrates and thus smell of acetone appears in her breath.

This symptom develops during fasting because during fasting, body utilizes fats and proteins as a source of energy and as a result, liver starts breaking down its fats into ketones such as acetone.