Question 26
62 year old Caucasian alcoholic male is brought to the ER in a semi-concious state. He remains drowsy and is unable to answer to questions. On examination, he is drowsy, responds to shaking, and then goes back to drowsiness. His Serum ketone levels are high, and his blood sugar level on glucometer shows 36 mg%. He has swelling on his great toes bilaterally. Serum AST is greater than ALT. Serum Bilirubin is 9.2 mg%. What is the biochemical cause of his swelling of toes?
A) Lactic Acid & Beta Hydroxy butyric Acid
B) Raised GGT
C) Hypertriglyceridemia
D) Mitochondrial Toxins
E) Increased NAD
3 comments:
Answer: A) Lactic & Beta Hydroxy butyric Acid.
In an alcoholic, the keto-acids compete with uric acid for excretion, and therefore these patients have potential for developing gouty arthritis.
Very useful post on USMLE.
Thanks,
Mark - USMLE Solutions
Absoultely, Latic acid and beta hyrdroxy butyric acid compete with Uric acid inorder to get excreted from the body. Ketoacids win in the end and uric acid pool keeps building on in the body.
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