monam84
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A 27 year old man with alcoholism is found unresposive after he drank large amounts of alcohol without eating over a 3 day period. His serum glucose is 30mg/dl. This finding is most due to increased hepatic concentration of: acetyl coa, ATP, lactate, NADH, PEP
I was torn between increased lactic acid and NADH can someone please help me with this one. Thanks.
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| SILVER
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isn't it something like this:- vit. B1 deficiency is common in alcoholics, so insufficient B1 will impair glucose oxidation. normally glucose oxidation is carried out by PDH which is thiamine dependent. if no thiamine, then PDH becomes inactive--->pyruvate accumalates--->and is acted on by LDH--->lactate
i haven't gotten to biochem yet.
anyone else?
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| doc179
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I think its due to NADH as NADH would drive the reaction towards 3P-glyceraldehyde and hence hypoglycemia.
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| SILVER
DoWhatYouGotToDo!
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doesn't ATP drive that reaction?
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| epica
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NADH
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| virgola82
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NADH is "reduction equivalent ready to be used" and therefore mimics high energy stores so liver reduce glucose production. High NADH corresponds to low NAD+ and this reduction impairs the glycolytic flux at the GAPDH reaction.
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| SILVER
DoWhatYouGotToDo!
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got it
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| monam84
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so do you think its NADH thats too high causing the hypoglycemia or the high lactate? i think its th high NADH from the conversion of ethanol to acetaldehyde thats resulting in DHAP --> glycerol 3-po4. Its a tricky question
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| doc179
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how can lactate cause hypoglycemia? its the product of anearobic glycolysis. increased NADH drives the pyruvate to form lactate and it also drives the DHAP to form glycerol 3 phosphate, I am very sure its NADH. Goljan says the same in his lecture.
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| monam84
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The reason why I considered lactate is because if ll the pyruvate is going to forming lactic acid then there will be less pyruvate and its substrtates (specifically malate from TCA) to reform glucose (gluconeogenesis). I have listened to GOljan as well, and I know that theres a high NADH/NAD ration but theres also lactic acidosis.
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| drprasanna
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i dont under stood the question please make it eloborate
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| doc179
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I guess we should be thing like this all of these reactions are driven by NADH and hence there is hypoglycemia. monam84...I am sorry if I offended you, it did not mean to be offensive, it was a just query. When I did NBME3 I think I had also picked lactate, but now when I think about it I feel NADH should be the answer. cos NADH is the key to drive all the reactions away from forming glucose.
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| monam84
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No way, you havent offended me, we're all here to learn  Yeah, i guess thebest answer would be NADH. Thanks for the help.
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