Liver Disease Starvation

This condition is called ketosis or acidosis. The acidosis, a decrease in pH of the blood, results from the elimination of the two acids in the urine as the ammonium or sodium salts. Ketosis and acidosis occur in diabetes, liver disease, starvation, alcoholism, and ingestion of a keto-genic diet (with large fat-carbohydrate ratio). 

Q5 Many factors can cause oedema. Anything which reduces plasma protein can cause oedema, for example starvation, liver disease (liver produces plasma proteins) and burns (because plasma and its protein is lost from the surface of burned skin). Increased capillary permeability in allergic or inflammatory conditions causes oedema. High arterial pressure or high venous pressure can also produce it in fact, anything which disturbs the hydrostatic and osmotic balance in the system or changes the capillary permeability which regulates tissue fluid formation can cause oedema. 

In a prospective cohort study including 24 infants, the incidence and risk factors of parenteral nutrition-associated liver disease (PNALD) was determined. Eight infants developed PNALD. The concluded that the duration of enteral starvation, gastrointestinal surgery, duration of enteral nutrition, maximum caloric and carbohydrate intakes were significant risks of PNALD in newborn infants [lob ll. In a retrospective review of the safety and efficacy of PN among 105 paediatric patients with bum injuries (>30% total-body sxuface area), no respiratory or blood infections were observed with the use of parenteral nutrition, and the overall mortality rate was 4% [107 ]. 

The anorexia suffered by cancer patients is likely to arise from a combination of psychological stress, altered senses of taste and smell and increased levels of cytokines, which influence the appetite and satiety centres in the hypothalamus. There are several consequences micronutrient intake will be diminished and this may contribute to the signs and symptoms of the disease. Plasma amino acid levels will fall, as in starvation (Chapter 16). Synthesis of glutamine (by muscle, adipose and lung), aspartate (by liver), glutathione (by the intestine) and arginine (by the kidney) will all be compromised. The metabolic significance of all of these is discussed in Chapter 18. 

The causes of blood deficiency are linked directly with deficiency of these four organs. It is often seen in chronic diseases, improper diet or in conditions of starvation. It can also occur following heavy blood loss. Long-term stress and overwork can directly weaken the Heart, Spleen, Liver and Kidney, causing blood deficiency. 

Apart from the site and route of administration, formulation, dosage, and duration of treatment, biotransformation is often also affected by several other factors including age, species differences, sex differences, diet, diseases, hormones, and environment. The activity of the liver microsomal enzymes is low in newborns and aging animals resulting in a slower rate of biotransformation. Species differences in dosage and response are often due to biotransformation differences. Inadequate protein intake approaching starvation may also decrease the rate of biotransformation (12). Diseases of the liver sometimes also interfere with the normal biotransformation capacity. In addition, increase in biotransformation may occur at high body temperatures because of an increase in the metabolic rate. 

Ketone body formation, which occurs within the matrix of liver mitochondria, begins with the condensation of two acetyl-CoAs to form acetoacetyl-CoA. Then acetoacetyl-CoA condenses with another acetyl-CoA to form /3-hydroxy-/3-methylglutaryl-CoA (HMG-CoA). In the next reaction, HMG-CoA is cleaved to form acetoacetate and acetyl-CoA. Acetoacetate is then reduced to form /3-hydroxybutyrate. Acetone is formed by the spontaneous decarboxylation of acetoacetate when the latter molecule s concentration is high. (This condition, referred to as ketosis, occurs in uncontrolled diabetes, a metabolic disease discussed in Special Interest Box 16.3, and during starvation. In both of these conditions there is a heavy reliance on fat stores and /3-oxidation of fatty acids to supply energy.)... 

If cortisone and hydrocortisone are not administered, the glycogen storages of the liver are rapidly depleted, and severe hypoglycemia results. The hypoglycemia may not be present at all times but occur only as a result of starvation or administration of a low-carbohydrate diet. Obviously, this hypoglycemic crisis cannot be relieved by epinephrine injection, and patients with Addison s disease are oversensitive to insulin. 

Water Excess. Sometimes excessive water accumulates in the tissues, specifically the interstitial compartment. Outwardly, this condition is noted as swelling and it may occur in any area of the body. It is called edema, though some may still call it dropsy. In general, there are four causes of edema (1) elevated fluid pressure in the capillaries as in heart failure (2) low osmotic pressure in the blood due to decreased blood protein in such conditions as liver cirrhosis, kidney disease, severe burns, and starvation (3) blockage of the lymph vessels as caused by the parasitic worm, filariae, in the disease elephantiasis or (4) increased capillary permeability due to the release of histamine in allergic reactions. Edema may require the restriction of dietary sodium and/or diuretics. 

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