The mother of a 17 year old girl brings her daughter to the doctor after she exp
ID: 258226 • Letter: T
Question
The mother of a 17 year old girl brings her daughter to the doctor after she experiences a number of fainting spells and lethargy. The mother states that her daughter eats practically nothing and is obsessed with exercise and losing weight. Her daughter states that she feels fat if she eats more. The girl is 5’6” and weighs 90 pounds. Physical examination shows loose skin folds and an abnormally low percentage of body fat.
A. Explain why she has an abnormally low percentage of body fat. What 3 tests would you recommend to confirm this and what results are you expecting from these tests? Explain why you expect these results.
B. What would you predict her nitrogen balance test will show? Explain why you expect this finding.
C. What vitamin supplements would you recommend that she take? Consider all the pathways that are active in her current state. List these pathways and the cofactors and the corresponding vitamins needed by the enzymes in each of these pathways.
Explanation / Answer
Please find the answers below:
Answer A: According to the information about the patient, it is highly likely that she suffers from anorexia nervosa, an obsessive condition in which the patient tends to loose weight to abnormally low levels. Thus, this extreme loss of weight has promoted excessive decrease in the body weight of this patient due to decline in total fat deposition in the body.
Under such conditions, a complete health check-up of the patient is recommended but following three tests are highly mandatory:
Answer B: The nitrogen balance test must show high ketone bodies in the urine and low amino acid content in the blood. Also, the total urea and uric acid content will demonstrate the water and ionic balance in the body.
Answer C: Since the patient is under-nourished, it is very likely that her bone density would be affected due to low calcium content and vitamin D deficiency. Also, her menstrual cycle might get affected due to low vitamin E. The skin folds have also loosend up due to deficiency of vitamin C. She is anemic as well as lacks hunger as well due to vitamin B complex deficiency. Hence, it is highly recommended that the patient should immediately start a complete multi-vitamin supplementation, especially vitamin D and B complex.
Presently, the urea cycle is highly active in this patient along with glycogenolysis as well. Since the enzymes needed in glycogenolysis requires pyridoxal or vitamin B6, a supplementation of vitamin B complex has been recommended.