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A Tragic Finding

Metabolism in an Alcoholic Patient


Anneke M. Metz
Medical/Dental Education Preparatory Program (MEDPREP)
Southern Illinois University School of Medicine


This interrupted case study utilizes real patient data and provides students an opportunity to apply knowledge of human metabolism and hormonal control to a complex real-world scenario. The story begins with the discovery of an unconscious patient who is determined to be simultaneously starving (having failed to eat for several days) and in a prolonged state of ethanol intoxication. Understanding the clinical outcome for this patient hinges on students synthesizing their understanding of a number of metabolic pathways and physiological principles that are frequently taught in isolation. The case thus provides much-needed practice in connecting multiple aspects of cellular-level metabolism to physiological (organ- and organism-level) outcomes. It is designed for advanced undergraduate biochemistry or physiology students who have already learned basic intermediary metabolism and the physiologic regulation of these metabolic pathways in different tissues by insulin and glucagon. The case works particularly well as a culminating exercise when students learn ethanol metabolism after learning many basic pathways of intermediary metabolism.


  • Demonstrate understanding of human intermediary metabolism, including aerobic and anaerobic respiration, lipolysis and beta-oxidation, glycogenolysis and gluconeogenesis, protein metabolism, the urea cycle and insulin/glucagon control of metabolism.
  • Demonstrate understanding of ethanol metabolism.
  • Predict the impact of ethanol intoxication on fasting-state metabolism.
  • Correlate the function of metabolic pathways to physiological outcomes and medical test results.
  • Formulate a hypothesis that explains a patient outcome by integrating understanding of human metabolism with provided physiological evidence.


Metabolism; alcoholism; hypoglycemia; gluconeogenesis; glycogenolysis; ketoacidosis; metabolic pathways; ethanol; insulin; glucagon; urea cycle

Topical Areas


Educational Level

Undergraduate upper division, Graduate, Professional (degree program), Clinical education



Type / Methods




Subject Headings

Biochemistry  |   Medicinal Chemistry  |   Medicine (General)  |   Nutrition  |   Physiology  |  

Date Posted


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