Saint Louis University

SCHOOL OF MEDICINE
Baguio City, Philippines

DEPARTMENT OF BIOCHEMISTRY

BIOCHEMISTRY LABORATORY: PROBLEM-BASED LEARNING EXERCISES
Enzymes


CASE 1

A 3 year old boy was playing in his grandfathers basement. He drank an unknown amount of
the insecticide malathion, which is used for killing fruit flies and other insects. Sometime later,
when he was not feeling well, the boy told his grandfather what he had done. The grandfather
retrieved the bottle and rushed the boy to the emergency room of the local hospital. On the way,
the boy vomited repeatedly and complained of abdominal cramps. At the hospital, he began
salivating and had an uncontrollable defecation.

In the emergency room, physicians passed a nasogastric tube for stomach lavage, started
intravenous fluids and recorded vital signs. The boys pulse rate was 48 beats per minute and his
blood pressure was 78/48 mmHg. The physician noted involuntary twitching of muscles in his
extremities.

QUESTIONS:

1. Explain the biochemical basis for the patients condition.

2. What drugs can be used in the treatment of this patient? Explain the biochemical
basis for administering these drugs.















CASE 2

A 54 year old woman, who is 68 inches tall and weighs 198 lbs., has a history of high blood
pressure and elevated serum cholesterol levels. After a heated argument with a neighbor, she
experienced a tight pressure-like band of pain across her chest, associated with shortness of
breath, sweating, and a sense of light-headedness.

After five hours of intermittent chest pain, she went to the hospital emergency department, where
her electrocardiogram showed changes consistent with an acute infarction of the anterior wall of
her heart. She was admitted to the cardiac care unit. Blood was sent to the laboratory for
various tests, including the total creatine kinase (CK) level and the MB fraction of CK in the
blood. cTN-T (cardiac troponin T subunit was also requested).

QUESTIONS:

1. Explain the biochemical basis for the laboratory tests that were requested for this patient.

2. Describe the clinical course of troponin T, CK-MB, as well as other related enzymes, in a
patient with myocardial infarction.

3. Describe the procedure used to isolate the different fractions of creatine kinase in the
laboratory, as well as the procedure used to measure troponin T.
























CASE 3

A 46-year-old male presents to the emergency department with severe right toe pain. The patient
was in usual state of health until early in the morning when he woke up with severe pain in his
right big toe. The patient denies any trauma to the toe and no previous history of such pain in
other joints. He did say that he had a few too many beers with the guys last night. On
examination, he was found to have a temperature of 38.2C and in moderate distress secondary
to the pain in his right toe. The right big toe was swollen, warm, red, and exquisitely tender. The
remainder of the examination was normal. Synovial fluid was obtained and revealed rod- or
needle-shaped crystals that were negatively birefringent under polarizing microscopy.

QUESTIONS:

1. What is the most likely diagnosis? Justify your answer.

2. Explain the biochemical basis for the patients condition.

3. The patient was started on allopurinol therapy. Explain the biochemical basis for this
treatment.



























CASE 4

A 59-year old male is brought to the emergency department by the EMS after a family member
found him extremely confused and disoriented, with an unsteady gait and strange irregular eye
movements. The patient has been known in the past to be a heavy drinker. He has no known
medical problems and denies any other drug usage. On examination, he is afebrile with a pulse of
110 beats per minute and a normal blood pressure. He is extremely disoriented and agitated.
Horizontal rapid eye movement on lateral gaze is noted bilaterally. His gait is very unsteady. The
remainder of his examination is normal. The urine drug screen was negative and he had a
positive blood alcohol level. The emergency room physician administers thiamine.

QUESTIONS:

1. What is the most likely diagnosis? Justify your answer.

2. Explain how alcohol is metabolized by the body.

3. Explain the biochemical basis for the administration of thiamine in this case.