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By U. Jaroll. Cooper Union for the Advancement of Science and Art. 2018.

A level above 200 mg/dL glycemia discount keftab 500 mg free shipping, which induces an osmotic diuresis buy keftab 750mg with visa, contributed to her dehydration and the defines “overt” diabetes mellitus. CHAPTER 4 / WATER, ACIDS, BASES, AND BUFFERS 51 Treatment was initiated with intravenous saline solutions to replace fluids lost The pKa for dissociation of ammo- with the osmotic diuresis and hyperventilation. Thus, the undis- increased urinary water volume to dilute the large amounts of glucose and ketone sociated conjugate acid form, NH , predominates at the physiologic pH of bodies excreted in the urine. Hyperventilation increased the water of respiration lost 4 7. A loading dose of regular insulin was given as an intravenous bolus an unusual conjugate base because it is not followed by additional insulin each hour as needed. While awaiting the report of his initial serum salicylate level, his stomach was lavaged, and several white tablets were found in the stomach aspirate. He was examined repeatedly and showed none of the early symptoms of salicylate toxicity, such as respiratory stimulation, upper abdominal distress, nausea, or headache. His serum salicylate level was reported as 92 g/mL (the usual level in an adult receiving a therapeutic dosage of 4 5 g/day is 120 350 g/mL, and a level of 800 g/mL is considered potentially lethal). He was admitted for overnight observation and continued to do well. A serum salicylate level the following morning was 24 g/mL. Veere complained of light- Water gain headedness and “pins and needles” (paresthesias) in his hands and around his lips. These symptoms resulted from an increase in respiratory drive mediated in this case through the “behavioral” rather than the “metabolic” central respiratory control system (as seen in Di Abietes when she was in dia- Fluids betic ketoacidosis).

Iron is absorbed from the diet cheap keftab 750 mg otc, transported in the blood in transferrin generic keftab 500 mg line, stored in ferritin, and used for the synthesis of cytochromes, iron-containing enzymes, hemoglobin, and myoglobin. It is lost from the body with bleeding and sloughed-off cells, sweat, urine, and feces. Hemosiderin is the protein in which excess iron is stored. Small amounts of ferritin enter the blood and can be used to measure the adequacy of iron stores. In the intestine, bacteria deconjugate bilirubin diglucuronide and convert the In an iron deficiency, what charac- bilirubin to urobilinogens (see Fig. Some urobilinogen is absorbed into the teristics would blood exhibit? However, most of the urobilinogen is oxidized to urobilins, such as stercobilin, and excreted in the feces. THE RED BLOOD CELL MEMBRANE Under the microscope, the red blood cell appears to be a red disc with a pale cen- tral area (biconcave disc) (Fig. The biconcave disc shape (as opposed to a spherical shape) serves to facilitate gas exchange across the cell membrane. The membrane proteins that maintain the shape of the red blood cell also allow the red blood cell to traverse the capillaries with very small luminal diameters to deliver oxygen to the tissues. The interior diameters of many capillaries are smaller than the approximately 7. Furthermore, in passing through the kidney, red blood cells traverse hypertonic areas that are up to six times the normal isotonicity, and back again, causing the red cell to shrink and expand during its travels. The spleen is the organ responsible for determining the viability of the red blood cells. Erythrocytes pass through the spleen 120 times per day. The elliptical passageways through the spleen are approximately 3 m in diameter, and 814 SECTION EIGHT / TISSUE METABOLISM RBC Hemoglobin 120 days Myoglobin Globin Amino acids R Cytochromes Heme E S Fe2+ CO Bilirubin BLOOD Bilirubin-albumin L Albumin UDP–Glucuronate I V E Bilirubin diglucuronide R Urine Urobilinogen Bile Bacteria Feces Stercobilin Fig.

It also can be syn- thesized from glucose via the polyol pathway buy keftab 500mg visa. Fructose The pentose phosphate pathway consists of both oxidative and nonoxidative is metabolized by conversion to intermediates components (Fig keftab 500 mg with visa. In the oxidative pathway, glucose 6-phosphate is oxidized of glycolysis. Ribulose 5-phosphate, a pentose, can be converted to ribose 5-phosphate for nucleotide biosynthesis. The NADPH is Enzymes can generally use either used for reductive pathways, such as fatty acid biosynthesis, detoxification of NADPH or NADH, but not both. This portion of 527 528 SECTION FIVE / CARBOHYDRATE METABOLISM Fatty acid synthesis Glucose 2 NADP+ 2 NADPH Glutathione reduction Other reactions Glucose Oxidative CO2 6–phosphate Ribulose 5–phosphate Xyulose Fructose 5–phosphate 6–phosphate Non-oxidative Ribose 5–phosphate Glyceraldehyde 3–phosphate NADH Nucleotide ATP biosynthesis Pyruvate Glycolysis The pentose phosphate pathway Fig. The pentose phosphate pathway gen- erates NADPH for reactions requiring reducing equivalents (electrons) or ribose 5-phosphate for nucleotide biosynthesis. Glucose 6-phosphate is a substrate for both the pentose phos- phate pathway and glycolysis. The 5-carbon sugar intermediates of the pentose phosphate pathway are reversibly interconverted to intermediates of glycolysis. The portion of glycoly- sis that is not part of the pentose phosphate pathway is shown in blue. One of the enzymes involved in these sugar intercon- The pentose phosphate pathway is versions, transketolase, uses thiamine pyrophosphate as a coenzyme. It shunts The sugars produced by the pentose phosphate pathway enter glycolysis as hexoses from glycolysis, forming pentoses, fructose 6-phosphate and glyceraldehyde 3-phosphate, and their further metabo- which may be reconverted to glycolytic lism in the glycolytic pathway generates NADH, adenosine triphsphate (ATP), and intermediates. The overall equation for the conversion of glucose 6-phosphate to fruc- tose 6-phosphate and glyceraldehyde 3-phosphate through both the oxidative and nonoxidative reactions of the pentose phosphate pathway is: 3 glucose-6-P 6 NADP S 3 CO2 6 NADPH 6 H 2 fructose-6-P glyceraldehyde-3-P. THE WAITING ROOM Candice Sucher is an 18-year-old girl who presented to her physician for a precollege physical examination.

In bright light order keftab 375 mg with mastercard, circular muscles contract and constrict the pupil generic keftab 750 mg line, limiting the light that enters the eye. In dim light, the radial muscles contract and di- late the pupil, allowing more light to enter the eye. When view- IN ✦ What muscles of the iris contract to make the pupil smaller? THE SENSORY SYSTEM ✦ 229 The ciliary (SIL-e-ar-e) muscle is shaped somewhat can form on the retina at this point, which is known as like a flattened ring with a central hole the size of the the blind spot or optic disk (see Figs. This muscle holds the lens in place The optic nerve transmits impulses from the retina to by means of filaments, called suspensory ligaments, that the thalamus of the brain, from which they are directed to project from the ciliary muscle to the edge of the lens the occipital cortex. Note that the light rays passing around its entire circumference (Fig. The ciliary through the eye are actually overrefracted (bent) so that muscle controls the shape of the lens to allow for vision an image falls on the retina upside down and backward at near and far distances. It is the job of the visual centers of the occurs as follows. The light rays from a close object diverge (separate) Three nerves carry motor impulses to the eyeball more than do the light rays from a distant object (Fig. Thus, when viewing something close, the lens must become more rounded to bend the light rays more and ◗ The oculomotor nerve (cranial nerve III) is the focus them on the retina. The ciliary muscle controls the largest; it supplies voluntary and involuntary motor shape of the lens. When this muscle is relaxed, tension on impulses to all but two eye muscles.