Ketone body metabolismDownloads

A 45-year-old man is brought to the emergency department by ambulance after vomiting blood. The patient reports that he only ate a small snack the morning before and had not eaten anything for over 24 hours. At the hospital, the patient is stabilized. He is admitted to a surgical floor and placed on NPO with a nasogastric tube set to intermittent suction. He has been previously diagnosed with liver cirrhosis. An esophagogastroduodenoscopy (EGD) has been planned for the next afternoon. At the time of endoscopy, some pathways were generating glucose to maintain serum glucose levels. Which of the following enzymes catalyzes the irreversible biochemical reaction of this process?

A 30-year-old woman is brought to the emergency department by ambulance after being found unconscious in her bedroom by her roommate. The roommate says the patient has type 1 diabetes and takes her insulin regularly. Her pulse is 110/min, the respiratory rate is 24/min, the temperature is 36.6°C (97.9°F), and the blood pressure is 95/65 mm Hg. She is breathing heavily and gives irrelevant responses to questions. Her skin and mucous membranes appear dry. Her breath has a fruity smell to it. Tendon reflexes are slightly delayed. The laboratory findings include: Finger-stick glucose 530 mg/dL Arterial blood gas analysis pH 7.1 pO2 94 mm Hg pCO2 32 mm Hg HCO3 17 mEq/L Serum Sodium 136 mEq/L Potassium 3.2 mEq/L Chloride 136 mEq/L Blood urea nitrogen 20 mg/dL Serum creatinine 1.2 mg/dL Urine examination Glucose positive Ketones positive Leucocytes negative Nitrite negative RBC negative Casts negative Which of the following abnormalities accounts for her sweet smelling breath?