Jill suffers from anorexia nervosa. One afternoon she is rushed to the emergency room because of cardiac arrhythmias. Her breath has the smell of an aromatic hydrocarbon (sweet, fruity odor), and blood and urine samples indicated ketonemia and ketonuria. Why do you think she is having the arrhythmias?

Question

What will be an ideal response?

Answer 1

It appears that Jill is suffering from ketoacidosis as a consequence of her anorexia. Because she is literally starving
herself, her body is metabolizing large amounts of fatty acids and amino acids to provide energy and in the process
is producing large quantities of ketone bodies (normal metabolites from these catabolic processes). One of the
ketones that is formed is acetone, which can be eliminated through the lungs. This accounts for the smell of
aromatic hydrocarbons on Jill's breath. The ketones are also converted into keto acids such as acetic acid. In large
amounts this lowers the body's pH. As the kidneys excrete excess H+, they reabsorb K+, leading to a state of
hyperkalemia. This is probably the cause of her arrhythmias. See the Running Problem throughout the chapter,
including its conclusion.