CASE STUDY DISCUSSIONS*(+ W^dad\nd[Y^hZVhZ
advised to eat a more appropriate diet including oily fish and vitamin rich
food, exercise regularly and stop smoking.DISCUSSION OF CASE STUDY 10.2
Emily’s ideal weight for her height is 120 pounds, so she is only approximately
8% below this value. Her blood glucose is only slightly reduced but the
ketone body content, indicative of a switch to fat metabolism (Chapter 7),
is increased although not excessively. However, given her dieting, exercising
and the evidence of a preoccupation with her weight, it is possible that
Emily is starting to suffer from AN, although she should be examined to
eliminate any other possible clinical causes, such as a neoplasm. She should
receive specialized counseling, especially in nutrition and for any emotional
problems perhaps related to academic issues that have led to her anorexic
behavior. Her family should be involved whenever possible.DISCUSSION OF CASE STUDY 10.3
Erythrocyte transketolase activity depends upon the thiamin derived
coenzyme, TPP. The activation coefficient of transketolase activity in John’s
sample was about 23% which is evidence for a moderate to approaching
severe deficiency. John should be placed on thiamin, and probably other
vitamin, supplements. Appropriate nutritional advice should also be given to
the nursing home.CHAPTER 11
DISCUSSION OF CASE STUDY 11.1
Alice has celiac disease where the degree of malabsorption depends on
the severity of the disease. Malabsorption of fat, protein and iron gave rise
to her steatorrhea, hypoalbuminemia and anemia respectively. The xylose
absorption test indicates defective carbohydrate absorption. The jejunal
biopsy confirms diagnosis of celiac disease. Alice should be placed on a
gluten-free diet and her symptoms should, hopefully, improve within three
weeks.DISCUSSION OF CASE STUDY 11.2
The urine bilirubin is negative and this means that the excess bilirubin in
serum must be unconjugated otherwise it would be in a water-soluble form
and lost in the urine. Normal AST and ALP activities suggest an absence
of hepatocellular damage. Hemolysis cannot be the cause of the raised
bilirubin as the hemoglobin concentration and reticulocyte count are both
within their reference ranges. It is likely that Sadaf is suffering from Gilbert’s
syndrome where there is reduced activity of UDP-glucuronyltransferase and
often decreased uptake of unconjugated bilirubin by liver cells. Gilbert’s
disease is characterized by mild jaundice, which is consistent with the
clinical findings.DISCUSSION OF CASE STUDY 11.3
The very high amylase activity suggests acute pancreatitis and this is
consistent with the clinical findings. Hyperglycemia occurs quite often in
acute pancreatitis but is transient in nature. Mark has a high serum urea
concentration. This is due to shock where the reduced blood flow to the
kidneys gives a reduced GFR and a resultant high serum urea concentration.