Volume 4, Module 1

Question 1

how does AKA (alcoholic ketoacidosis) occur?

Answer 1

multifactorial;

1. malnourished = low glycogen stores
2. increased lipolysis = poor nutritional intake, low insulin levels, increased sympathetic nervous system activity from decreasing alcohol levels
3. inhibited hepatic gluconeogenesis

Question 2

• metabolism of ethanol by acetaldehyde dehydrogenase (ADH) = decrease in oxidized nicotinamide adenine dinucleotide (NAD+) to nicotinamide adenine dinucleotide hydride (NADH)
• increased NADH/NAD+ ratio = inhibited hepatic gluconeogenesis and production of β-hydroxybutyrate from acetoacetate
• also lactate forms from pyruvate

Answer 2

AKA metabolism

Question 3

constellation of features c/w propofol infusion syndrome (PRIS)

Answer 3

• metabolic acidosis
• hypotension
• bradycardia
• fever
• AKI
• rhabdomyolysis
• RBBB

Question 4

other findings that can occur w/ PRIS

Answer 4

• acute fatty liver
• hypertriglyceridemia
• precordial ST segment elevations