Chapter 24
Nutrition, Metabolism, and Body Temperature Regulation
953
Related Clinical Terms
Appetite
A desire for food. A psychological phenomenon dependent
on memory and associations, as opposed to hunger, which is a
physiological need to eat.
Familial hypercholesterolemia
(hi
0
per-ko-les
0
ter-ol-e
9
me-ah). An
inherited condition in which the LDL receptors are absent or
abnormal, the uptake of cholesterol by tissue cells is blocked, and
the total concentration of cholesterol (and LDLs) in the blood is
enormously elevated. Atherosclerosis develops at an early age,
heart attacks begin in the third or fourth decade, and most die
by age 60 from coronary artery disease. Treatment entails dietary
modifications, exercise, and cholesterol-reducing drugs.
Kwashiorkor
(kwash
0
e-or
9
kor) Severe protein and calorie deficiency
which is particularly devastating in children, resulting in mental
retardation and failure to grow. A consequence of malnutrition
or starvation, it is characterized by a bloated abdomen because
the amount of plasma proteins is inadequate to keep fluid in the
bloodstream. Skin lesions and infections are likely.
Marasmus
(mah-raz
9
mus) Protein-calorie malnutrition,
accompanied by progressive wasting. OFen due to ingesting
food of very poor quality. Growth for age is severely stunted.
Pica
(pi
9
kah) Craving and eating substances not normally considered
nutrients, such as clay, cornstarch, or dirt.
Skin-fold test
Clinical test of body fatness. A skin fold in the back of
the arm or below the scapula is measured with a caliper. A fold
over 1 inch in thickness indicates excess fat. Also called the fat-
fold test.
AT T H E C LI N I C
Kyle Boulard, a 35-year-old male, is
believed to be one of the primary
causes of the accident on Route
91. Passengers on the bus reported
that Mr. Boulard was clearly intoxicated when he boarded the
bus. According to these reports, Mr. Boulard behaved erratically,
appeared disoriented, and left his seat and staggered down the
aisle. Just prior to the accident, he had stumbled into the driver’s
compartment. Paramedics found Mr. Boulard in a disoriented state
when they arrived on the scene, but noted only minor injuries. A
“fruity acetone combined with alcohol” smell was noted on his
breath. What follows is a summary of the notable test results:
General
Blood
Urine
BP: 95/58
pH: 7.1
Odor: “fruity acetone”
HR: 110
Glucose: 345 mg/dl
pH: 4.3
 
Ketone bodies:
22 mg/dl
Glucose: strongly positive
 
Blood alcohol:
110 mg/dl
1.
Urine glucose is usually negative. Using the information in
Appendix F, look up normal values for blood pH, blood glucose,
blood ketone bodies, and urine pH, and identify whether each
test result is normal or abnormal.
2.
A “fruity acetone combined with alcohol” smell was detected
in Mr. Boulard’s breath, and in his urine. Which substance is
producing the “fruity acetone” smell?
3.
Where in the body are ketone bodies produced? What energy
source does the body use to produce these substances?
4.
The production of large amounts of ketone bodies is often seen
when glucose is not readily available as an energy source (e.g.,
in starvation). In Mr. Boulard’s case, large amounts of glucose
are in the blood. Explain why his body is producing ketones in
the presence of such large amounts of glucose.
5.
Explain how the pH of Mr. Boulard’s blood and urine is related
to the ketone bodies measured in each of these fluids.
(Answers in Appendix H)
 
Case Study
Nutrition and Metabolism
24
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