Introduction

Carbohydrates, • Macromolecule

Lipids, Proteins and • “macro” big

• Big molecules
Vitamin • Polymer
• “poly” many
• A macromolecule made of repeating units called
CPH Lecture
monomers.

Carbohydrates
• Monosaccharides: simple sugars =monomer (glucose,
• Carbohydrates have the general formula Cn(H2O)n fructose and galactose)
• 3 main roles: • Disaccharides: two simple sugars linked by covalent
bonds (maltose, lactose and sucrose)
• Source of stored energy
• Oligosaccharides: three to 20 monosaccharides
• Transport stored energy
• Polysaccharides: hundreds or thousands of
• Carbon skeletons that can be rearranged to form monosaccharides (starch, glycogen, cellulose)
new molecules

 Pathways in Glucose Metabolism

• Glucose is a primary source of energy for humans. The Metabolism of glucose molecule to pyruvate or lactate for
nervous system including the brain, totally depends on Glycolysis
production of energy.
glucose from the surrounding extracellular uid for
Formation of glucose-6-phosphate from noncarbohydrate
energy. Gluconeogenesis
sources.
• Nervous tissue cannot concentrate or store
Glycogenolysis Breakdown of glycogen to glucose for use as energy.
carbohydrates, therefore it is critical to maintain a steady
supply of glucose to the tissue.
Glycogenesis Conversion of glucose to glycogen for storage.
• When the concentration of glucose falls below a certain
level, the nervous tissue loses the primary energy source Lipogenesis Conversion of carbohydrates to fatty acids.
and is incapable of maintaining normal function.
Lipolysis Decomposition of fats.

Regulation of Carbohydrate Metabolism

Action of Insulin Hyperglycemia
Increase glycogenesis and glycolysis: glucose- glycogen - pyruvate -acetyl-CoA
• Increase in plasma glucose levels. In healthy patients,
during a hyperglycemia state, insulin is secreted by
Increases lipogenesis the B-cells of the pancreatic islets of Langerhans.
Decreases glycogenolysis • Insulin enhances membrane permeability to cells in
the liver, muscle, and adipose tissue.
Action of Glucagon
• Hyperglycemia, or increased plasma glucose levels,is
Increases glycogenolysis: glycogen - glucose caused by an imbalance of hormones.
Increases gluconeogenesis: fatty acids- acetyl CoA - ketone, proteins - amino acids

Laboratory ndings in Hyperglycemia • Hypoglycemia

• Increased glucose in plasma and urine • Involves decreased plasma glucose levels and can have
many causes-some are transient and relatively insigni cant,
• Increased urine speci c gravity but others can be life threatening.
• Increase serum and urine osmolality • The warning signs and symptoms of hypoglycemia are all
related to the central nervous system.
• Ketones in serum and urine
• Decreases blood and urine pH (acidosis)
• Electrolyte imbalance

Causes of Hypoglycemia Proteins

• Every function in the living cell depends on proteins.
Patient Appears Healthy Patient Appears Ill
• Motion and locomotion depend on contractile proteins— muscle movement, for
example:
Drugs
• All biochemical reactions are catalyzed by enzymes, which contain protein.
Insulinoma
Islet hyperplasia/ nesidioblastosis Drugs • The structure of cells and the extracellular matrix that surround the cells is largely
Factitial hypoglycemia from insulin Predisposing illness made of the protein group collagens. Collagens are the most abundant protein in
the human body.
or sulfonylurea Hospitalized patients
Severe exercise • The transport of materials in the body uids depends on proteins such as
Ketotic hypoglycemia transferrin, receptors for hormones are transmembrane proteins, and
transcription factors.
• Proteins make up antibodies, which are major component of the immune system.

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 Lipids
Nitrogen Content
• Commonly referred to as fats, are ubiquitous
• Proteins consist of the elements carbon, oxygen, hydrogen, constituents of all living cells and have a dual role.
nitrogen and sulfur. It is the fact that proteins contain
nitrogen that sets them apart from pure carbohydrates and • Lipids are composed of mostly carbon-hydrogen
lipids, which do not contain nitrogen atoms. (C-H) bonds, they are a rich source of energy and
an e cient way for the body to store excess
calories.
• Lipids are also precursors for the steroid hormones,
prostaglandins, leukotrienes, and lipoxins.

• Serum lipids (fats) are complex group of substances which are Vitamins
characterized by their insolubility in water and solubility in non-
polar organic solvents • Vitamins serve as cofactors in many enzymatic reactions, so that these
enzymes have low catalytic activity in cellular reactions if vitamins are
• In serum the lipids are soluble mainly because they combine with not present.
proteins to form lipoproteins.
• These compounds and their biologically inactive precursors must be
• Some clinically signi cant lipids include: partially obtained from food sources and some from bacterial synthesis.
• • Total serum lipids • Triglycerides
• Vitamins of diverse chemical structure are classi ed as either water
soluble or fat soluble.
• Steroids • Phospholipids
• Fat soluble includes A, D, E and K.
• Prostaglandins • Lipoproteins
• Those vitamins soluble in water include the B-complex vitamins—
• Fatty acids • Vitamin A, D, E and K
thiamine, ribo avin, niacin, vitamin B6 and B12, biotin, folate, and
• Cholesterol vitamin C.
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 Water-Soluble Vitamins Clinical De ciency

Infants: dyspnea, cyanosis, diarrhea, vomiting

Vitamin B1
• When cellular vitamin and activity levels from diet or intestinal absorption or Adults: beri-beri, Wernicke-Korsako syndrome (apathy, ataxia, visual problems)
inadequate, it is termed vitamin de ciency. Vitamins, classi ed as fat or
water soluble, and the symptoms usually seen in de ciency states are Vitamin B2 Angular stomatitis, dermatitis, photophobia, neurologic changes
shown below:
Infants irritability, seizures, anemia, vomiting, weakness
Vitamin B6
FAT-SOLUBLE VITAMINS CLINICAL DEFICIENCY Adults: Facial seborrhea

Night blindness, growth retardation, abnormal taste response, dermatitis, Niacin Pellagra (dermatitis, mucous membrane in ammation, weight loss)
VITAMIN A1
recurrent infections

VITAMIN E Mild hemolytic anemia (newborn), red blood cell fragility, ataxia Folic Acid Megaloblastic anemia

VITAMIN D Rickets (young), osteomalacia (adult)

Vitamin B12 Megaloblastic anemia, neurologic abnormalities

VITAMIN K Hemorrhage, especially post-traumatic bleeding

Scurvy (hemorrhages into skin, alimentary and urinary tract, anemia, delayed wound
Vitamin C
healing)

Reference: Clinical Chemistry 7th Edition by Bishop

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