Nitrogen Metabolism Flashcards
How many grams of CHON are turnover per day?
300-400g/day
Sum of all CHON degraded and resynthesized from AA
Amino acid pool
There are the energy producing metabolic pathways
Glycolysis
Krebs cycle
What is the 1st step in 1st phase of AA catabolism
Transamination
Second step in AA catabolism
Oxidative deamination
Enzyme in transamination
Amino transferase
A ketoglutarate –> glutamate
Coenzyme in transamination
Pyridoxal phosphate - Vit B6
Enzyme in
Glutamate –> ammonia/ NH3
Glutamate dehydrogenase
Enzyme in
Glutamate + NH3 = glutamine
Glutamine synthetase
Glutamine –> NH3
Glutaminase
Where does urea cycle occur? In body and cell
Liver
Mitochondria & cytosol
Rate limiting step in urea cycle?
Nh3 + Co2 –> carbamoyl phosphate
Carbamoyl phosphate synthetase 1
Allosteric activator: n-acetylglutamate
MC heriditary hyperammonemia
Ornithine transcarbomylase deficiency
most severe hereditary hyperammonemia
Carbamoyl phosphate synthetase -1 deficiency
Purely ketogenic AA
Lysine
Leucine
Glucogenic and ketogenic
TRY PHilippine ISlands. TY
Tryptophan
Phenylalanine
Isoleucine
Tyrosine
Congential deficiency of HOMOGENTISATE OXIDASE
In the degradative pathway of tyrosine leading to build up of homogentisic acid
Alkaptonuria
Urine turns black on standing, ochronosis (connective tissue is dark), athralgias
Benign
Alkaptonuria
Tx of alkaptonuria
Reduce phenylalanine and tyrosine in diet
Vit c for older children and adults
What enzyme is absent in albinism?
Tyrosinase
Albinism: risk for skin ca
Most common deficiency in homocystinuria
Cystathionine B-synthase
Homocystinuria is a defect in what AA
Methionine
Coenzyme of methionine synthase
Methylcobalamin
Coenzyme of cystathionine B-synthase
Pyridoxal phosphate
What condition has Ectopia lentis (downward displacement) MR MI Stroke
Homocystinuria
Treatment for homocystinuria
Restriction of methionine
Limit eggs, fish, meat
Supplementation: B6, B12, folate
Cystinuria is an inherited defect of renal tubular amino acid transporter for _____ in PCT of kidneys
COLA Cystine Ornithine Lysine Arginine
What calculi found in cystinuria
Staghorn calculi
Tx for cystinuria
Acetazolamide
To alkalanize the urine
Methylmalonic acidemiia is a deficiency in?
Methylmalonyl CoA mutase
Defect in conversion of methlymalonyl CoA to succinyl CoA
Presents with seizure, encephalopathy, stroke (1 mo- 1 yr)
Hypotonia, lethargy, failure to thrive, hepatosplenomegaly, monilial infx
Methylmalonic acidemia
Tx for Methylmalonic acidemia
Protein restricted diet
(0.5-1.5 g/kg/d)
With L-carnitine and cobalamin supplementation
Branched amino acids
VIL
Valine
Isoleucine
LEUcine
Blocked degradation of branched AA due to a deficiency in
A-ketoacid dehydrogenase complex
Tx for maple syrup urine dse
Dietary restriction
Rate limiting step in heme synthesis
Formation of aminolevulinic acid
Glycine + succinyl CoA –> aminolevulinic acid
Enzyme?
Glycine + succinyl CoA –> aminolevulinic acid
ALA synthase
Co factor in formation in aminolevulinic acid
Pyridoxine
B6
This causes inactivation of ALA dehydratase and ferrochelatase
Lead poisoning
What condition has microcytic, hypochromic anemia
With basophilic stippling of RBCs
Headache, memory loss
Peripheral neuropathy, claw hand, wrist drop, GI symptoms,
Lead poisoning
Disorder due to abnormalities in pathway of biosynthesis of heme
Porphyrias
Result in accumulation and increased excretion of porphyrins or porphyrin precursors
Most common porphyrias
Porphyria cutanea tarda
Presents with photosensitivity, neuropsych symptoms, abdominal pain
Porphyrias
Enzyme in formation of bilirubin in heme degradation
Heme oxygenase
Heme –> biliverdin (green) –> bilirubin (red orange)
Bilirubin transported to the liver in the blood binds to
Albumin
In heme degradation
Bilirubin is conjugated to 2 mol of
Glucoronic acid
Enzyme ini formation of bilirubin diglucoronide
Bilirubin glucuronyltransferase
Deficient in Crigler-Najjar I and II
and Gilbert syndrome
Bilirubin glucuronyltransferase
Results from an elevated level of plasma bilirubin
Jaundice
Used to measure bilirubin in serum
Van den Bergh reaction
Involved in well fed state
Insulin
Involved in fasting state
Glucagon
Located at B cells of islets of Langerhans
Insulin
Located at alpha cells of islets of Langerhans
Glucagon
2 polypeptide chains with 51 AA linked together by 2 disulfide bridges
Insulin
Single polypeptide chain with 29 AA
Glucagon
2nd messenger of insulin
Tyrosine kinase
2nd messenger of glucagon
- cAMP
Stimulus for secretion
Ingestion of glucose and AA
Cholecystokinin and gastric inhibitory polypeptide
Insulin
Stimulus for secretion
Actual or potential hypoglycemia
Glucagon
Enzyme in phosphorylation
Pyruvate kinase (glycolysis)
Enzyme in dephosporylation
Glycogen synthase (glycogenesis)
In fed state brain uses _____ exclusively as fuel
Glucose
In fasting state brain uses ______ and ______ as fuel
Glucose
Ketone bodies
Erythrocytes uses ____ exclusively as fuel during well fed state
Glucose
In fasting state
Erythrocyte uses _____ as fuel
Glucose
This provides energy source and snynthesize ketone bodies during fasting state
Beta oxidation
Pathway that produces NADPH
PPP
_____ for beta oxidation
FA
____ for gluconeogenesis
Glycerol
During marathon and fasting this provides skeletal muscle with energy (major source)
May also use ketone bodies
Fatty acids
Principle site of metabolism of branched chain amino acids
Skeletal muscle
Can act as energy store for short term demands
Phosphocreatine
Iron transport protein in plasma
Transferrin
MC micronutrient deficient worldwide
Iron deficiency anemia
Iron overload syndrome with progressive hemosiderosis and resulting organ damage
May lead to liver cirrhosis, liver cancer, DM, cardiomyopathy, hyperpigmentation of skin, endocrine disorders and joint pain
Hemochomatosis
Treatment for hemochromatosis
Repeated phlebotomy
Most abundant trace mineral in the body after iron, with total body stores of about 1.5 to 2.5g
Zinc
Leads tp dermatitis and poor wound healing, hair loss, neuropsychiatric impairments, decreased taste acuity
And in children, poor growth and testicular atrophy
Zinc deficiency
Presents with microcytic hypochromic anemia, leukopenia, hemorrhagic vascular changes, bone demineralization, hypercholesterolemia, neurological problems
Seen in: pts receiving total parenteral nutrition and in infants
Copper deficiency
Deficiency of an ATP-dependent membrane transporter for copper
Growth retardation, mental deficiency, seizures, arterial aneurysms, bone demineralization, brittle hair
Menkes syndrome
Intestinal absorption of copper is intact but its biliary excretion is blocked
Copper accumulation in liver and brain, with resulting liver damage, neurological deterioration, or both
Wilson disease
Kayser-fleisher rings
Wilson disease
Treatmetn for wilson disease
D-penicillamine
Which forms a soluble excretable copper complex
Excess can cause psychosis and parkinsonism
Manganese madness
This occurs in few oxidase enzymes, including xanthine oxidase
Molybdenum
Low selenium content causing cardiomyopathy
Keshan disease