A 26-year-old man is brought to the emergency department due to progressive confusion. His roommate says that he has been binge drinking for the last 5 days and probably has had very little to eat. The patient's medical history is significant for alcohol-related seizures 1 year ago. He had been sober until 2 weeks ago, when he started drinking again. The patient's past medical history is otherwise unremarkable. On examination, he responds to voice but does not follow commands. Fingerstick glucose is 35 mg/dL and urine is strongly positive for ketones. Suppression of which of the following is the primary cause of this patient's hypoglycemia?

Question

A 26-year-old man is brought to the emergency department due to progressive confusion.  His roommate says that he has been binge drinking for the last 5 days and probably has had very little to eat.  The patient's medical history is significant for alcohol-related seizures 1 year ago.  He had been sober until 2 weeks ago, when he started drinking again.  The patient's past medical history is otherwise unremarkable.  On examination, he responds to voice but does not follow commands.  Fingerstick glucose is 35 mg/dL and urine is strongly positive for ketones.  Suppression of which of the following is the primary cause of this patient's hypoglycemia?

Quizplus · Accepted Answer

Eductional Objective: The metabolism of ethanol by alcohol dehydrogenase and aldehyde dehydrogenase reduces NAD+ to NADH and increases the NADH/NAD+ ratio. This inhibits all other pathways requiring NAD+, including reactions required for gluconeogenesis. In particular, lactate cannot be converted to pyruvate, and instead the reaction is driven from pyruvate toward lactate. In addition, excess NADH inhibits the conversion of malate to oxaloacetate. Pyruvate and oxaloacetate are intermediates in gluconeogenesis; therefore, conversion of these molecules to lactate and malate inhibits gluconeogenesis.

A 26-Year-Old Man Is Brought to the Emergency Department Due