Fasting, hypoglycemia caused

The answer is C. Pyruvate kinase deficiency is ruled out by the elevated serum lactate levels. The coma is associated with a fasting hypoglycemia, which is indicative of pyruvate carboxylase deficiency. The elevated citrulline and lysine in the serum are due to a reduction of aspartic acid levels, which are caused by the reduced levels of oxaloacetate, the product of the pymvate carboxylase reaction. 

We ll never know what caused Steve Braun s mysterious illness. Candidiasis gets blamed for just about everything these days (but Ebstein-Barr is gaining fast). Hypoglycemia, the diagnosis of the 60 s, seems to be losing popularity. 

Ms. Selmass s doctor explained that the general diagnosis of "fasting" hypoglycemia was now established and that a specific cause for this disorder must be found. 

Co-trimoxazole can cause reversible hypoglycemia, which may be prolonged, particularly in patients with risk factors for hypoglycemia. Common risk factors include compromised renal function, prolonged fasting, malnutrition, and the use of excessive doses. It has been postulated that the sulfonamide mimics the action of sul-fonylureas, stimulating pancreatic islet cells to secrete insulin. In elderly people, co-trimoxazole-induced hypoglycemia can cause altered mental state (1146,1147). 

The importance of the liver is shown by the failure of hyperglycemia to occur when the liver is depleted of glycogen by fasting. Either total adrenalectomy or removal of the adrenal medulla alone prevents postinjury hyperglycemia and may cause hypoglycemia. 

In a double-blind, randomized, crossover study in 10 healthy subjects, subcutaneous glucagon-like peptide-1 after a 16-hour fast caused a near five-fold rise in plasma insulin concentration and circulating plasma glucose concentrations fell below the reference range in all subjects (6). One subject had symptoms of hypoglycemia. A rise in pulse rate correlated with the fall in plasma glucose concentration and there was an increase in blood pressure. 

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