Question

A 78 year old patient with cancer of the esophagus has not been able to eat, has lost 80 pounds and appears cachectic (extremely thin & wasted; the noun is cachexia). His breath smells fruity, like acetone. His pH is 7.14 and HCO3 18.

Link aspects of his clinical presentation to the pathophysiology underlying them.
a. Patient can't eat hypoglycemiainsulin secreted from pancreas triggers glycogenolysis as a back-up plan raises blood sugar but byproducts include ketones.
b. Difficulty breathing increased metabolic needsuses up all energy sources body begins
to use HCO3 as source of energyHCO3 depleted HCO3 decreases to 18, causing pH to increase from normal to 7.14.
c. Chronic illnessincreased stressincrease in counterregulatory hormonesglycogenesis triggeredtoo much glucose being stored rather than being readily availablecachexia.
d. Given the description of the patient's debilitated state, he is probably in sustained gluconeogenesisgives energy but also increases accumulation of ketones body tries to get rid of them via many ways, including as acetone in the breath.

Answer 1

Ketosis is a condition characterized by the accumulation of ketone bodies in the blood, which can lead to diabetic ketoacidosis. In this case, the patient's weight loss and cachexia may be explained by increased fatty acid oxidation and the production of ketone bodies, including acetone. The fruity smell of the patient's breath is a characteristic symptom of ketosis.

Step-by-step explanation:

Ketosis is a condition characterized by the accumulation of ketone bodies in the blood, which can lead to diabetic ketoacidosis. In this case, the 78-year-old patient with cancer of the esophagus is experiencing weight loss and cachexia, which may lead to a state of prolonged starvation and increased fatty acid oxidation. As a result, there is an increase in the concentration of acetyl-CoA, which cannot be oxidized due to a decrease in oxaloacetate. This leads to the formation of ketone bodies, including acetone, which is expelled in the breath, causing it to smell fruity.