Case 11: Acute starvation: A 23-year-old woman living alone depressed after the termination of her engagement. Two mont

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Case 11: Acute starvation:
A 23-year-old woman living alone depressed after the termination
of her engagement. Two months later she was brought to the
emergency room by a friend because of weakness and lethargy.
She appeared thin and pale. Questioning revealed that
she had not eaten for several weeks. Analysis of the plasma
sample indicated elevated levels of alanine, acetoacetate,
beta-hydroxybutyrate, and blood urea nitrogen (BUN).
However, her plasma glucose level was within the normal range.
She was hospitalized, given intravenous feeding and
antidepressant medication, and subsequently switched to an 1800 cal
(7500 KJ) diet. Her recovery was uneventful.
Discuss this case applying your knowledge on carbohydrate,
lipid, and amino acid metabolism to answer the following
questions.
1. How was the patient's body obtaining energy during the time
she was not eating?
2. How was the patient able to maintain her plasma glucose level
within the normal range even though she was not eating?
3. What does elevation in plasma alanine indicate? Why is the
BUN elevated?
5. Why are her plasma acetoacetate and beta-hydroxybutyrate
levels high?
6. Would you expect to see similar conditions in a patient with
an uncontrolled diabetic condition? Why?