Starvation and Malnutrition

Question 1

What is the typical presentation of a patient with pancreatic insufficiency?

Answer 1

• Diarrhea
• Steatorrhea
• Malabsorption and weight loss
• Deficiency in ADEK vitamins

Question 2

What are the symptoms of serotonin syndrome

Answer 2

• Muscle rigidity
• Hyperthermia
• Cardiovascular collapse

Question 3

What fuels are produced and used in the post absorptive period?

Answer 3

• Produced: Glucose from hepatic glycogenolysis and gluconeogenesis
• Used: muscles, brain, and other tissues use predominantly glucose

Question 4

When does gluconeogenesis begin in the post-absorptive period?
When does it become fully active?

Answer 4

• Begins 4-6 hours after last meal

- fully active when glycogen stores are depleted (10-18 hours after last meal)

Question 5

What are the 4 fates of Acetyl CoA?

Answer 5

• TCA cycle
• Fatty acid synthesis
• Cholesterol synthesis
• Ketone synthesis

Question 6

Describe Kwashiorkor

Answer 6

• Protein malnutrition
• Fatty liver disease
• Can’t make ApoB100 —> lipids accumulate in liver
• edema
• anemia
• skin lesions
• depigmentation of skin and hair

Question 7

Pneumonic for Kwashiorkor

Answer 7

• “FLAMES”
• Fatty liver
• Anemia
• Malnutrition
• Edema
• Skin lesions

Question 8

Describe Marasmus

Answer 8

• Total energy Malnutrition
• Muscle wasting
• Loss of subcutaneous fat
• edema

Question 9

Describe Refeeding syndrome

Answer 9

• Can occur in those with negligible food intake for 5 days
• Drop in serum levels of magnesium, phosphate, and potassium . . can cause arrythmias and neurologic problems
• Cells also phosphorylate all these things to trap them inside . . . depletion of ATP

Question 10

How does the pattern of fuel production and usage change in EARLY starvation (24 hours after the last meal)

Answer 10

• Glucose and fatty acids produced
• Brain uses predominantly Glucose
• Muscles and other tissues use some glucose but predominantly fatty acids

Question 11

In INTERMEDIATE starvation (48 hours after the last meal), how does the pattern of fuel production and utilization change

Answer 11

• Glucose, Fatty acids, and Ketone bodies produced
• Brain uses predominantly glucose but also some ketone bodies
• Muscles and other tissues used predominantly fatty acids but also some ketone bodies

Question 12

What metabolic scenaria favors the synthesis of Ketone bodies

Answer 12

-When production of acetyl CoA from beta-oxidation of fatty acids exceeds the oxidative capacity of the TCA cycle

Question 13

True or False? Ketone bodies can be used by all body tissues including the brain

Answer 13

False. RBCs can only use Glucose

Question 14

What is the pattern of fuel production and utilization in PROLONGED starvation (5 days after last meal)

Answer 14

• Glucose, Fatty acids, and ketone bodies produced
• Brain uses predominantly Ketone bodies
• Muscles and other tissues use predominantly Fatty acids but also some Ketone bodies and glucose

Question 15

What are the main Ketone bodies

Answer 15

• Acetoacetate

- Beta-hydroxybutyrate

Question 16

What ketone makes a slightly fruity smell to breath

Answer 16

-Acetoacetate —->Acetone

Question 17

What is the rate limiter in Ketogenesis

Answer 17

-HMG-CoA SYNTHASE

Question 18

What does a urine test for ketones test for?

Answer 18

• ONLY Acetoacetate

- NOT beta-Hydroxybutyrate

Question 19

Describe why someone who consumes alcohol after not eating for a while becomes hypoglycemia?

Answer 19

• Liver chooses to metabolize the ethanol rather than produce glucose via gluconeogenesis
• while metabolizing ethanol it increases NADH
• The NADH shunts Pyruvate to Lactate (via Glycolysis) and Oxaloacetate to Malate (via TCA cycle)
• This means that Pyruvate and oxaloacetate are no longer available for gluconeogenesis