A 35-year old woman became severely depressed after the sudden death of her husband. Two months later, she was brought to the emergency room by her friend because of extreme weakness and lethargy. She appeared thin and pale. Upon history taking, the doctor found that she had not eaten for several weeks. Analysis of the plasma sample indicated elevated levels of alanine, acetoacetate, β-hydroxybutyrate and blood urea nitrogen (BUN). However, her plasma glucose concentration was low (55mg/dL). She was hospitalized, given intravenous feeding, antidepressant medications and subsequently shifted to a 1800kCal (7500kJ) diet. Her recovery was uneventful. Why did the patient have elevated levels of alanine, acetoacetate, β-hydroxybutyrate and blood urea nitrogen (BUN)? How could the patient maintain her plasma glucose levels within normal limits even though she was not eating? Suggest, why the patient’s recovery was smooth after being shifted to a 1800kCal diet.

Biochemistry
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ISBN:9781319114671
Author:Lubert Stryer, Jeremy M. Berg, John L. Tymoczko, Gregory J. Gatto Jr.
Publisher:Lubert Stryer, Jeremy M. Berg, John L. Tymoczko, Gregory J. Gatto Jr.
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A 35-year old woman became severely depressed after the sudden death of her husband. Two months later, she was brought to the emergency room by her friend because of extreme weakness and lethargy. She appeared thin and pale. Upon history taking, the doctor found that she had not eaten for several weeks. Analysis of the plasma sample indicated elevated levels of alanine, acetoacetate, β-hydroxybutyrate and blood urea nitrogen (BUN). However, her plasma glucose concentration was low (55mg/dL). She was hospitalized, given intravenous feeding, antidepressant medications and subsequently shifted to a 1800kCal (7500kJ) diet. Her recovery was uneventful.

Why did the patient have elevated levels of alanine, acetoacetate, β-hydroxybutyrate and blood urea nitrogen (BUN)?
How could the patient maintain her plasma glucose levels within normal limits even though she was not eating?
Suggest, why the patient’s recovery was smooth after being shifted to a 1800kCal diet.

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