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Veere complained of light- Water gain headedness and “pins and needles” (paresthesias) in his hands and around his lips cheap modafinil 200mg with mastercard. These symptoms resulted from an increase in respiratory drive mediated in this case through the “behavioral” rather than the “metabolic” central respiratory control system (as seen in Di Abietes when she was in dia- Fluids betic ketoacidosis) purchase modafinil 200mg on line. Veere’s case by 1500 mL his anxiety over his grandson’s potential poisoning. Veere’s PaCO2 to decrease below the normal range of 37 to 43 mm Hg. After being reassured Solid food Fuel metabolism 800 mL 400 mL that his grandson would be fine, Mr. Veere was asked to breathe slowly into a small paper bag placed around his nose and mouth, allowing him to reinhale the CO2 being exhaled through hyperventilation. Water loss Expired air BIOCHEMICAL COMMENTS 400 mL Evaporation Body water and dehydration. Dehydration, or loss of water, occurs and sweat when salt and water intake is less than the combined rates of renal plus 600 mL extrarenal volume loss (Fig. In a true hypovolemic state, total body water, functional ECF volume, and ICF volume are decreased. One of the causes of Urine Feces hypovolemia is an intake of water that is inadequate to resupply the daily excretion vol- 1500 mL 100 mL ume (maintenance of fluid homeostasis). The amount of water lost by the kidneys is determined by the amount of water necessary to dilute the ions, acids, and other solutes excreted. Both urinary solute excretion and water loss in expired air, which amount to Fig. Body fluid homeostasis (constant almost 400 mL/day, occur during fasting as well as during periods of normal food body water balance). Thus, people who are lost in the desert or shipwrecked continue to lose water availability of fluids and food, thirst, hunger, in air and urine, in addition to their water loss through the skin and sweat glands.

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Children with this disorder develop nine aminotransaminase (ALT) and may be converted back to pyruvate by a rever- renal failure by 6–12 years of age order 200 mg modafinil with amex. Alanine is the major gluconeogenic amino acid because it is produced in many tissues for the transport of nitrogen to the liver proven modafinil 200mg. Alanine aminotransferase (ALT) and aspartate amino transferase III. AMINO ACIDS RELATED TO TCA CYCLE (AST) are released from the liver INTERMEDIATES when liver cells are injured. Measurement of these two transaminases in the serum (ALT Two groups of amino acids are synthesized from TCA cycle intermediates; one and AST) is one of the standard laboratory group from -ketoglutarate and one from oxaloacetate (see Fig. During tests for liver damage caused by a variety of degradation, four groups of amino acids are converted to the TCA cycle intermedi- conditions. CHAPTER 39 / SYNTHESIS AND DEGRADATION OF AMINO ACIDS 719 Methionine SH CH2 CH2 − + OOC CH CH2OH H C NH3 + − NH3 COO Serine Homocysteine PLP cystathionine synthase − H2O − OOC CH CH2 S + NH3 CH2 CH2 Succinyl CoA Homocysteine is oxidized to a + disulfide, homocystine. To indicate H C NH3 that both forms are being consid- COO− L-Methylmalonyl CoA ered, the term homocyst(e)ine is used. Cystathionine H2O D-Methylmalonyl CoA Homocysteine cystathionase PLP COO– COO– NH+ 4 α-Ketobutryate Propionyl CoA + + H3N CH H3N CH − CH2 CH2 OOC CH CH2 SH + CH CH NH3 2 2 Cysteine SH S O2 SH S – − OOC CH CH2 SO2 CH2 CH2 + NH3 CH2 CH2 + + Cysteine sulfinic acid C C 3 3 α-Ketoglutarate – – PLP COO COO Glutamate Homocysteine Homocystine Pyruvate Because a colorimetric screening test for uri- nary homocystine was positive, the doctor 2− SO3 ordered several biochemical studies on Sulfite Homer Sistine’s serum, which included tests for methionine, homocyst(e)ine (both free 2− and protein-bound), cystine, vitamin B12, SO4 ATP Sulfate PAPS and folate. The level of homocystine in a 24- hour urine collection was also measured. The results were as follows: the serum Urine methionine level was 980 M (reference Fig. Cysteine is synthesized from the carbons range, 30); serum homocyst(e)ine (both and nitrogen of serine and the sulfur of homocysteine (which is derived from methionine). Based on these measurements, Homer Sistine’s doctor concluded that he had homocystinuria caused by an enzyme defi- ciency.

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The major metabolic fuel for participating in a prolonged aerobic exercise event is which of the following? A 24-hour urine collection showed that an individual’s excretion of creatinine was much lower than normal cheap 200mg modafinil visa. Decreased excre- tion of creatinine could be caused by which of the following? In the biosynthetic pathways for the synthesis of heme generic 100mg modafinil, creatine, and guanine, which one of the following amino acids directly provides carbon atoms that appear in the final product? In skeletal muscle, increased hydrolysis of ATP during muscular contraction leads to which of the following? The most abundant cell in the nervous system is the glial cell, which consists of astrocytes and oligodendrocytes in the central nervous system, and Schwann cells in the peripheral nervous sys- tem. These cells provide support for the neurons and synthesize the protective myelin sheath that surrounds the axons emanating from the neurons. Microglial cells in the nervous system act as immune cells, destroying and ingesting foreign organisms that enter the nervous system. The interface between the brain parenchyma and the cerebrospinal fluid compartment is formed by the ependymal cells, which line the cavities of the brain and spinal cord. These cells use their cilia to allow for the circulation of the cerebrospinal fluid (CSF), which bathes the cells of the central nervous system. The cells of the brain are separated from free contact with the rest of the body by the blood-brain barrier. The capillaries of the brain exhibit features, such as tight endothelial cell junctions, that restrict their permeability to metabolites in the blood. This protects the brain from compounds that might be toxic or otherwise interfere with nerve impulse transmission. It also affects the entry of precursors for brain metabolic pathways such as fuel metabolism and neurotransmitter synthesis.

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