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The Metabolic Medicine Postoperative Bariatric Surgery Consultation
Published in Michael M. Rothkopf, Jennifer C. Johnson, Optimizing Metabolic Status for the Hospitalized Patient, 2023
Michael M. Rothkopf, Jennifer C. Johnson
The next major factor to consider in the postoperative bariatric patient is electrolyte balance. It is not uncommon to see underlying electrolyte disturbances in these patients, either because of medications (such as diuretics) or a history of fad dieting. As in the malnourished patient, hypokalemia, hypophosphatemia and hypomagnesemia need to be monitored carefully. The hospital recovery period should be used to correct these electrolyte disturbances if they are found. The levels should be normalized prior to the patient’s discharge. Remember that the patient will be on a very limited oral intake over the subsequent few weeks. Furthermore, they often enter nutritional ketosis that can further deplete electrolytes. Under these conditions, even a mild electrolyte deficiency can worsen quickly. Missing this step may end up requiring an ER visit or a readmission (Jammah 2015).
Fluorescent Technology in the Assessment of Metabolic Disorders in Diabetes
Published in Andrey V. Dunaev, Valery V. Tuchin, Biomedical Photonics for Diabetes Research, 2023
Elena V. Zharkikh, Viktor V. Dremin, Andrey V. Dunaev
Redox studies at the level of cells and biological tissues are often used, in particular, to assess wound healing processes in diabetic and normal conditions. Several studies conducted in rodents have shown the usefulness of such method for assessing the wound healing ability [54,55]. Some studies have analyzed the difference in the AGE/NADH ratio between diabetics and healthy controls [56]. They reported a significant increase in this ratio among the former group. Evaluation of the NADH/FAD ratio may have an important diagnostic value in the diagnosis of tissue oxygen metabolism disorder in DM [57]. However, it is worth noting the difficulty of using such an analysis for in vivo assessment of the risks of developing complications at the organ level. Of particular interest is the noninvasive measurement of the fluorescence of NADH and FAD in the skin, hindered by the presence of high concentrations of collagen in the skin tissue, which has its own fluorescence in the same spectral range.
Isovaleric acidemia
Published in William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop, Atlas of Inherited Metabolic Diseases, 2020
William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop
Isovaleryl CoA dehydrogenase, a member of the acylCoA dehydrogenase family, is made as a 45 kDa subunit precursor [60] and processed to a 43 kDa during import into the mitochondria and then assembled as a tetramer. It is a flavine adenine dinucleotide (FAD)-containing enzyme, whose electrons are transferred to electron transfer flavoprotein (ETF) and transmitted to coenzyme Q of the electron transport chain by ETF dehydrogenase [61].
Exploring the contribution of mitochondrial dynamics to multiple acyl-CoA dehydrogenase deficiency-related phenotype
Published in Archives of Physiology and Biochemistry, 2021
Sofia R. Brandão, Rita Ferreira, Hugo Rocha
During fasting conditions triacylglycerides are mobilized from adipose tissue, transported and distributed to various tissues through the bloodstream in lipoproteins (Houten and Wanders 2010). Once inside the cells, fatty acids are activated to their coenzyme A (CoASH) esters and transported into mitochondria for subsequent β-oxidation (Houten and Wanders 2010, Wanders et al.2010, Longo et al.2016). The main function of mitochondrial fatty acid β-oxidation (FAO) is to generate acetyl-coenzyme A (acetyl-CoA) and reducing equivalents such as flavin adenine dinucleotide (FADH2) and nicotinamide adenine dinucleotide (NADH) to be used at the Krebs cycle and oxidative phosphorylation (OXPHOS) system, leading to energy production in the form of adenosine triphosphate (ATP) (Houten and Wanders 2010, Wanders et al.2010). OXPHOS is the key metabolic pathway in mitochondrial energy production. It requires the action of five multi heteromeric complexes located in the inner mitochondrial membrane, designated complexes I to V (Smeitink et al.2001, Papa et al.2012). Electron transfer flavoprotein (ETF) and electron transfer flavoprotein dehydrogenase (ETFDH) are essential proteins for the activity of flavoproteins (Lund et al.2015), allowing the delivery of electrons to ubiquinone (CoQ). Indeed, crystallographic studies support the interplay of these two proteins during electron and hydrogen transfer (Toogood et al.2007). Therefore, they make the connection between the β-oxidation cycle and OXPHOS.
Non-alcoholic Wernicke’s encephalopathy: toxic ingestion or an honest mis-steak?
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Salahuddin Nasir, Moustafa Abou Areda, Elise L. Ma, Robert D. Chow, Avelino Verceles, Carol Chiung-Hui Peng
Thiamine is a water-soluble vitamin that is essential to energy metabolism. The body’s thiamine stores can be depleted without supplementation within 3 to 6 weeks. The average requirement per day is 1.0–2.0 mg of thiamine, which can be found through a variety of dietary sources, including vegetables and fruits[18]. It is becoming increasingly important to be aware of non-alcoholic WE as a potential consequence of fad-diets, which have been construed to yield a variety of benefits, including management of mood disorders, diabetes, arthritis, and weight loss. Fortunately, based on the published cases [4,7,10,15,17] as well as our case, early diagnosis and initiation of nutritional support are able to correct the nutritional imbalance and reverse the adverse neurological consequences[19].A thiamine serum measurement is not required to make this diagnosis as it is a clinical diagnosis made using the presenting symptomatology. A delay in diagnosis and treatment, however, can result in prolonged metabolic derangement, leading to irreversible brain damage with short-term memory loss, termed Korsakoff’s psychosis[2].
Diagnostic challenges in metabolic myopathies
Published in Expert Review of Neurotherapeutics, 2020
Corrado Angelini, Roberta Marozzo, Valentina Pegoraro, Sabrina Sacconi
About 700 MADD patients have been reported all over the world [40–54,55,56,57,58,59,60,61] and over 600 were affected by RR-MADD. The mutational spectrum of RR-MADD shows various types of variants identified in the ETFDH gene. The majority are missense [55,56,57,58,59,60,61,62,63,64] mutations (73%), the other variants are frameshift (13%), splice site variations (8%), and nonsense mutations (6%) [49]. Patients presenting RR-MADD carry at least one missense variation that impair FAD binding, which plays a central role in the conformational stabilization of flavoenzymes and might change the catalytic activity and the folding of flavoprotein [62,63,64,6666,67,68,69,70]. The riboflavin supplementation likely increases the intra-mitochondrial FAD concentration, promoting FAD binding. To investigate the stability and activity of ETFDH, several studies have been performed with fibroblasts obtained from MADD patients. These studies have demonstrated an increase of protein stability, mild impairment of native folding of ETFDH, and the rescue of its enzymatic activity with riboflavin treatment.