e the specific cellular compartment where the above reaction occurs. above reaction occurs in what metabolic pathway? What is the purpose of this pathway? In what organ does pathway take place? Briefly diagram this pathway, including all molecules and enzymes.

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Part II - Diagnosing the Patient
You review with the physician your thoughts about the results of the patient's blood work. Elevated WBC count may
indicate an infection or inflammation. Elevated levels of AST, ALT, and ammonia indicate excess nitrogen processing
by the liver. However, the low BUN level indicates that ammonia is not being released as urea but instead into the
blood, causing hyperammonemia.
The ER physician nods in approval and tells you that excess ammonia in the brain can cause neurological damage
by inducing changes in the transport of the excitatory amino acid neurotransmitter glutamate, altering brain energy
metabolism, and changing the neuronal electric activity by inhibiting the generation of synaptic potentials.
He orders the nurse to collect more blood and urine samples for additional testing. He also orders hemodialysis for the
patient to reduce the amount of ammonia in the blood and prevent further neurological damage. (Hemodialysis is a
treatment that removes toxins from the blood through a dialyzer, a device that acts as an artificial kidney.)
The blood and urine tests come back, and the physician allows you to examine the results (Tables 2 and 3).
Table 2. Concentrations of specific amino acids in blood plasma.
Amino Acid
Patient's Result
Normal Range
68-104
Arginine (umol/L)
53
Citrulline (umol/L)
10
20-60
Glutamine (μmol/L)
1300
420-700
Glutamate (µmol/L)
140
10-50
Ornithine (µmol/L)
26
20-70
Table 3. Concentrations of specific amino acids in urine.
Amino Acid
Patient's Result
Glutamine (mmol/mol creatinine)
Orotic Acid (mmol/mol creatinine)
170
120
Normal Range
<100
<5
Transcribed Image Text:Part II - Diagnosing the Patient You review with the physician your thoughts about the results of the patient's blood work. Elevated WBC count may indicate an infection or inflammation. Elevated levels of AST, ALT, and ammonia indicate excess nitrogen processing by the liver. However, the low BUN level indicates that ammonia is not being released as urea but instead into the blood, causing hyperammonemia. The ER physician nods in approval and tells you that excess ammonia in the brain can cause neurological damage by inducing changes in the transport of the excitatory amino acid neurotransmitter glutamate, altering brain energy metabolism, and changing the neuronal electric activity by inhibiting the generation of synaptic potentials. He orders the nurse to collect more blood and urine samples for additional testing. He also orders hemodialysis for the patient to reduce the amount of ammonia in the blood and prevent further neurological damage. (Hemodialysis is a treatment that removes toxins from the blood through a dialyzer, a device that acts as an artificial kidney.) The blood and urine tests come back, and the physician allows you to examine the results (Tables 2 and 3). Table 2. Concentrations of specific amino acids in blood plasma. Amino Acid Patient's Result Normal Range 68-104 Arginine (umol/L) 53 Citrulline (umol/L) 10 20-60 Glutamine (μmol/L) 1300 420-700 Glutamate (µmol/L) 140 10-50 Ornithine (µmol/L) 26 20-70 Table 3. Concentrations of specific amino acids in urine. Amino Acid Patient's Result Glutamine (mmol/mol creatinine) Orotic Acid (mmol/mol creatinine) 170 120 Normal Range <100 <5
6. Name the specific cellular compartment where the above reaction occurs.
7. The above reaction occurs in what metabolic pathway? What is the purpose of this pathway? In what organ does
this pathway take place? Briefly diagram this pathway, including all molecules and enzymes.
Transcribed Image Text:6. Name the specific cellular compartment where the above reaction occurs. 7. The above reaction occurs in what metabolic pathway? What is the purpose of this pathway? In what organ does this pathway take place? Briefly diagram this pathway, including all molecules and enzymes.
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What source was the information "As mentioned above these reactions occur in the metabolic pathway called ornithine cycle which is responsible for the formation of urea in liver. This cycle converts highly toxic ammonia into urea and prevents ammonia toxicity. This cycle takes place in the  in the liver. " found (provide a URL)

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