Answer

1. Glukoneogenesis
In this case, Ms. A has lack energy source when she spent too much energy for
giant activity. In order to fulfill the body requirement, gluconeogenesis occurred for
supply more energy. Gluconeogenesis (abbreviated GNG) is a metabolic pathway that
results in the generation of glucose from non-carbohydrate carbon substrates such as
pyruvate, lactate, glycerol, glucogenic amino acids, and odd-chain fatty acid.
It is one of the two main mechanisms humans and many other animals use to keep
blood glucose levels from dropping too low (hypoglycemia). The other means of
maintaining blood glucose levels is through the degradation of glycogen
(glycogenolysis).
Gluconeogenesis is a ubiquitous process, present in plants, animals, fungi,
bacteria, and other microorganisms. In vertebrates, gluconeogenesis takes place
mainly in the liver and, to a lesser extent, in the cortex of kidneys. In ruminants, this
tends to be a continuous process. In many other animals, the process occurs during
periods of fasting, starvation, low-carbohydrate diets, or intense exercise. The process
is highly endergonic until ATP or GTP are utilized, effectively making the process
exergonic. For example, the pathway leading from pyruvate to glucose-6-phosphate
requires 4 molecules of ATP and 2 molecules of GTP. Gluconeogenesis is often
associated with ketosis. Gluconeogenesis is also a target of therapy for type II
diabetes, such as metformin, which inhibits glucose formation and stimulates glucose
uptake by cells. In ruminants, because metabolizable dietary carbohydrates tend to be
metabolized by rumen organisms, gluconeogenesis occurs regardless of fasting, low-
carbohydrate diets, exercise, etc.












Pathways
Gluconeogenesis is a pathway consisting of a series of eleven enzyme-
catalyzed reactions. The pathway may begin in the mitochondria or cytoplasm, this
being dependent on the substrate being used. Many of the reactions are the reversible
steps found in glycolysis.
Gluconeogenesis begins in the mitochondria with the formation of
oxaloacetate by the carboxylation of pyruvate. This reaction also requires one
molecule of ATP, and is catalyzed by pyruvate carboxylase. This enzyme is
stimulated by high levels of acetyl-CoA (produced in -oxidation in the liver) and
inhibited by high levels of ADP.































Fig 1. Glukoneogenesis Pathways

Oxaloacetate is reduced to malate using NADH, a step required for its
transportation out of the mitochondria.
Malate is oxidized to oxaloacetate using NAD+ in the cytosol, where the
remaining steps of gluconeogenesis take place.
Oxaloacetate is decarboxylated and then phosphorylated to form
phosphoenolpyruvate using the enzyme phosphoenolpyruvate carboxykinase. A
molecule of GTP is hydrolyzed to GDP during this reaction.
The next steps in the reaction are the same as reversed glycolysis. However,
fructose-1,6-bisphosphatase converts fructose-1,6-bisphosphate to fructose 6-
phosphate, using one water molecule and releasing one phosphate. This is also the
rate-limiting step of gluconeogenesis.
Glucose-6-phosphate is formed from fructose 6-phosphate by
phosphoglucoisomerase. Glucose-6-phosphate can be used in other metabolic
pathways or dephosphorylated to free glucose. Whereas free glucose can easily
diffuse in and out of the cell, the phosphorylated form (glucose-6-phosphate) is
locked in the cell, a mechanism by which intracellular glucose levels are controlled by
cells.
The final reaction of gluconeogenesis, the formation of glucose, occurs in the
lumen of the endoplasmic reticulum, where glucose-6-phosphate is hydrolyzed by
glucose-6-phosphatase to produce glucose. Glucose is shuttled into the cytoplasm by
glucose transporters located in the endoplasmic reticulum's membrane.

Reference (Harper Biochemistry, http://en.wikipedia.org/wiki/Gluconeogenesis,
Silva, Pedro. "The Chemical Logic Behind Gluconeogenesis". Retrieved September 8,
2009)

2. She Suffer URTI?
Upper respiratory tract infections, (URTI or URI), are the illnesses caused by an acute
infection which inv olves the upper respiratory tract: nose, sinuses, pharynx or larynx.
The infection is related to human immunodeficiency system. In this case, ms A should
be lack in immune regulation which related to her bad metabolism. It will open more
chance for viral infection that cause URTI.

Reference (http://www.respiratoryspecialists.com.sg/common/Upper_Respiratory)

3. Interpretation Cholesterol, HDL, LDL, Na and K
The amount of cholesterol in normal regulation should be under 200 mg/dl. In
this case, ms A which has 135 mg/dl still in normal range. LDL range is under 100
mg/dl and HDL should be 40 mg/dl to 55 mg/dl. Ms. A still in normal range for HDL
and LDL. Abnormal range of these can increase the risk of heart attack and stroke. Its
mean there is not any disease or problem with his cholesterol, HDL and LDL range.
The normal range for blood sodium levels is 135 to 145 milliequivalents per
liter (mEq/L). Abnormal sodium levels can be due to many different conditions.
A higher than normal sodium level is called hypernatremia. It may be due to:
Cushing syndrome, Diabetes insipidus, Hyperaldosteronism, Increased fluid loss due
to excessive sweating, diarrhea, use of diuretics, or burns.
A lower than normal sodium level is called hyponatremia. This may be due to
Addison's disease, Dehydration, vomiting, diarrhea. In the case of ms A there is 135
mEq/L. It shows a normal condition of Na in her body.
Many conditions can affect potassium levels. High blood potassium levels
may be caused by damage or injury to the kidneys. This prevents the kidneys from
removing potassium from the blood normally. High blood potassium levels can also
be caused by conditions that move potassium from the body's cells into the blood.
These conditions include severe burns, crushing injuries, heart attack, and diabetic
ketoacidosis. Taking too many potassium supplements can also cause high levels of
potassium in the blood. Too much acid (pH) in the blood makes potassium levels
higher by causing the potassium in the body's cells to "leak" out of cells and into the
blood. Some medicines, such as angiotensin-converting enzyme (ACE) inhibitors, can
cause high potassium levels.











As an adult, ms A has 2,8 mEq/L of Potassium. These lower condition may
cause her body weak. Low blood potassium levels can be caused by high levels of
aldosterone (hyperaldosteronism) made by the adrenal glands. Other conditions that
can cause low blood potassium levels include severe burns, cystic fibrosis,
alcoholism, Cushing's syndrome, dehydration, malnutrition, vomiting, diarrhea and
certain kidney diseases, such as Bartter's syndrome. Bartter's syndrome is a condition
characterized by enlargement of certain kidney cells. It is more common in children
and may be associated with an abnormally short stature (dwarfism). The cause of
Bartter's syndrome is not fully known. Medicines, such as diuretics, are a common
cause of low potassium levels.

4. Advice for lactose intolerant.
If you think you have lactose intolerance, it is a good idea to talk it over with
your doctor. Your doctor can make sure that your symptoms are caused by lactose
intolerance and not by another problem such as irritable bowel syndrome,
inflammatory bowel disease, overuse of laxatives, or problems digesting foods that
contain fructose or sorbitol. Your doctor can also make sure that your lactose
intolerance is not related to another health problem.
After being diagnosed with lactose intolerance, you may feel relieved to find
out what has been causing your symptoms. You may also feel frustrated by having to
deal with this condition for the rest of your life. You may find it reassuring to know
that there are many people who have lactose intolerance and most can avoid
discomfort and still eat or drink some milk products throughout the day.
There are different ways to live with lactose intolerance. What works for one
person may not work for another. Because there is no cure for lactose intolerance,
controlling your symptoms is mostly up to you. The following tips can help you
prevent symptoms of lactose intolerance.
Limit the amount of milk and milk products in your diet. Most people can
have about 10 g of lactose each day. This can be a glass of whole, low-fat, or fat-free
milk, for example. All milk contains the same amount of lactose. Other milk products
contain different amounts of lactose.

Foods with less lactose, such as Swiss or cheddar cheese, may not cause problems. If
you are not sure whether a milk product causes symptoms, try a small amount and
wait to see how you feel before you eat or drink more.
Eat or drink milk and milk products along with other foods. For some people,
combining a solid food (like cereal) with a dairy product (like milk) may reduce or
eliminate symptoms. Spread milk or milk products throughout the day. Many people
who are lactose-intolerant find it helpful to eat small amounts of lactose-containing
products throughout the day instead of larger amounts all at one time. Eat or drink
milk and milk products that have reduced lactose. In most grocery stores, you can buy
milk with reduced lactose. Some people like buying this kind of milk and find that it
helps control their symptoms. Others find that it tastes too sweet or is too expensive.
People who have diabetes may find that lactose-reduced milk raises their blood sugar
levels higher than normal.