Prolonged Starvation Due to Inability to Obtain Food - Lab Report Example

Malnutrition Associated With Insufficient Intake of Nutrients Following A Prolonged Starvation Due to Inability to Obtain Food Name Instructor Date Brief and Accurate Case History Summary An adult soldier was found lying unconscious in a quite arid land within the Somalia and Eretria borders which is a scene of guerrilla conflict. Somalia and Eretria are known for feminine (Masci, 2002). It was suspected that the soldier could have become detached from his group after a conflict and maybe become lost without any provisions. He was taken to the medical camp by a number of volunteers. A physical examination was carried out to establish any medical conditions. He did not present any sign of infection nor fever. His body seemed to have no wounds, although he remained comatose with breathing that was shallow and frail pulse. The soldier had some water in his bag; however, he did not have food when he was found. This means that possibly the soldier had not eaten any food except water. He was not able to obtain any food because he got lost from his group who had the provisions. Since glucose plays a big role in the provision of energy to the central nervous system (Butterly & Shepherd, 2010). It is therefore right to say that he did not have enough glucose for the brain and that is why he was unconscious. It is clear that the level of activity of soldiers is very high and deprivation of food leads to starvation which in turn results to low levels of glucose in the brain. The region has a natural source of water where several soldiers obtained their water from. However, the area is devoid of edible plants and animals to hunt. The soldiers depend on a several hundred kilometer provision chain for prerequisites apart from water. One of the Red Cross volunteer discovers the gaunt soldier is indeed wasted in appearance. It is suspected that the soldier could be going through starvation. It is evident that Red Cross plays an important role in the areas that are arid. For instance, they provide medical camps for people who live in the arid areas. This is a good impact for the health and lives of people in general, otherwise many lives could be lost. An initial diagnosis consistent with the case study The initial diagnosis is starvation. The rationale behind this diagnosis is that the soldier was lying unconscious and this means that he had not had food for a while and therefore there was no enough supply of glucose in the brain. His body did not have any wounds, he had a superficial breathing and his pulse was weak. When he was found, the soldier did not have any food with him, but some water in his bag. It is clear that the region had availability of water but there were neither edible fruits nor animals to hunt. This means that the soldiers had to depend on the provisions they were offered several kilometer supply chain. Since the soldier was disconnected from his group, and was found without any food except water, he might have been very hungry for a long period until he became unconscious. During the physical examination, it was evident that he was wasted. A brief introduction to biochemistry theory to support the initial diagnosis There are several factors that are involved in food intake regulation. For example, in healthy individuals, consumption of food on a daily basis can be regulated proximately by hormonal regulation of appetite and levels of activity, all of which are finally related to providing homeostatic control of metabolic biochemistry (Nelson, Cox & Lehninger, 2008). However, there are animals that are adapted to enduring very long durations without water or food. A number of these periods of fasting are connected to unavailability of food. For obvious purposes, an immense deal of effort has been undertaken on the need food in individuals and starvation has been molded deeply with laboratory animals. A number of animals have survived with no food for more than twelve months, although fasting for long is not a routine characteristic of human behavior. During the initial days of deprivation of food, named phase 1, the reserves of hepatic glycogen are almost entirely exhausted as the body defends levels of circulating glucose (Pathways, 2011). Glucose is an essential energy for the central nervous system. In the case above, starvation in biochemical sense is brought about due to lack of glucose and not food. During starvation, the body depends on proteins and fat. Fat is a grand substrate for production of ATP. Via beta oxidation, the body is capable of breaking down the fatty acids in components of two carbons, which ultimately go through the TCA cycle (Pathways, 2011). Glycerol obtained from triglycerides in fat is able to become glucose via various reactions. Protein from tissue is also broken down to acquire single aminoacids, which can intimately enter the TCA cycle as well, while others are turned into glucose for brain fueling. Gluconeogenesis is the generation of glucose from precursors which are non-carbohydrates, like lactate, pyruvate, TCA cycle intermediates and certain amino acids (Pathways, 2011). Gluconeogenesis is dynamic during starvation. The process of gluconeogenesis is: 2 pyruvate + 4 ATP + 2 GTP + 2 NADH + 2 H2O ----> glucose + 4 ADP + 2 GDP + 2 NAD+ + 6 Pi DG = - 37.6 kJ/mole Even during conditions of starvation, the level of blood-glucose needs to be sustained above 2.2 mM. The primary precedence of metabolism in starvation is to give enough glucose to the brain and various tissues like red blood cells that are completely dependent on this source of energy. However, glucose precursors are not plentiful. A lot of energy is reserved in the triacylglycerols’ fatty acyl moieties. The triacylglycerol’s glycerol moiety is able to be converted into glucose, however, only a restricted quantity is available (Castellini & Rea, 2010). The purely other potential basis of glucose is amino acids generated from the proteins breakdown. However, proteins are not reserved, and therefore any breakdown shall call for a loss of function. Hence, the preservation of proteins becomes the second precedence of metabolism during starvation, which is achieved through shifting the energy being utilized from glucose to ketone bodies and fatty acids (Castellini & Rea, 2010). A set of appropriate tests to carry out There are a number of tests which can be performed following the initial diagnosis made. 1) Blood tests: Blood urea nitrogen for kidney function diagnosis. This test is ruled out the presence of kidney problems although prolonged starvation results into an increase of uric acid in urine (Butterly & Shepherd, 2010). Glucose for checking or diagnosing hypoglycemia which is insulin induced or diabetes. The test ruled out the presence of diabetes. On the other hand, this test supports the initial diagnosis because demanding physical activity like a soldier’s work and fasting is a supreme integration to reduce blood glucose quickly and result to loss of consciousness. The rationale for this is that gluconeogenesis is not able to provide sufficient glucose to support the muscle’s need for an energy substrate during hard work. Phosphorous and calcium for diagnosing the function of the kidney and the nutritional condition of the patient. Since the soldier was deprived food for a period of time, it is evident that his nutritional status was a bit drained. Total protein and Albumin is used to diagnose nutrition, liver disease and water balance (Haerens, 2009). This test is also effective since it supports the initial diagnosis. The soldier’s nutritional status was drained. Complete Blood Count (CBC) is used to determine heart, kidney, blood and nutritional statusb(Haerens, 2009). It was effective to carry out this test since the nutritional condition of the soldier was poor, hence his emaciative look. 2) Urine tests Direct observation visually: evaluated for normal color, quantity, and clarity. The urine of the soldier was normal in the color, the quantity was good although the clarity was poor. This is because it is possible that the soldier had taken enough water, although the effects of starvation caused poor clarity but normal quantity. pH: standard pH needs to be slightly acidic at 6. Specific Gravity: urine density provides an idea of how good the kidneys are functioning and if there is extra glucose in the urine. Protein: determines the effectiveness of kidneys functioning. The soldier’s kidneys were functioning effectively. Glucose: establishes the possibility of diabetes. The possibility of diabetes was ruled out. Ketones: determines starvation or diabetes. Diabetes was ruled out although features of starvation were presented. For a normal function of the brain, a stable level of blood glucose is absolutely important. The brain is able to use ketone bodies or glucose as its fuel. Ketone bodies (beta-hydroxybutyrate or acetyl acetate) are not able to replace glucose as the source of energy for the brain on short notice. Approximately 10-14 days are needed to enhance the levels of plasma ketone body such that they are able to generate energy for tissues that are neutral. Nitrites: determines bacterial infection. Bacterial infection was ruled out since the soldier’s body did not have any wound or signs of infections. A set of fictitious data Analyte Initial Result Specimen Units Reference Urea: may increase in urine during starvation or remain within the standard limit. 4.2 urine mmol/L 3.3-6.6 Albumin: decreases when individuals do not consume sufficient protein. 32 serum g/L 35-50 Calcium: calcium is important in the body and prolonged starvation may lead to its insufficiency. 2.20 Whole blood mmol/L 2.10-2.55 Glucose: blood glucose intensively decreases during starvation. This is because the process of gluconeogenesis is not sufficient to generate enough glucose to the brain. 3.6 serum mmol/L 3.9-6.1 pH: the level of pH may remain within the normal range depending on the severity of the starvation. 6.8 6.45-7.45 Protein: the protein level is considerably reduced during starvation because the body derives the source of energy from muscle protein during starvation. 40 serum g/L 60-80 Specific gravity which determines the functioning of the kidneys may be within the normal range depending on the state of the kidneys. 1.010 1.003-1030 Urea nitrogen (BUN): this increases during starvation. 4.5 Serum or plasma mmol/L 4.2-8.2 Ammonia increases during starvation. 30.5 plasma mol/L Read More