Life depends on the oxidation of carbon. Carbohydrates are used as glucose, stored as glycogen in the liver, and the excess deposited in the body as fat. Unfortunately, fats cannot, to any considerable extent, be reconverted into glucose; furthermore, sufficient glucose must be available to maintain combustion of fats; otherwise the higher fatty acids will not undergo complete combustion, and acetone and diacetic acid will appear in the tissues and cause a toxemia, which in the more severe grades may terminate in coma, as in cases of diabetes.
On the contrary, proteins can, to a considerable extent, be converted into glucose, but they contain nitrogen. Under stress, as in cases of starvation or hepatic disease, sufficient glucose is not available; the protein tissues of the body are broken down for the purpose of producing the necessary glucose, and the resultant excess nitrogen must be excreted in the urine as urea
WALTERS W, MAYO WJ. ABNORMAL FUNCTION OF THE LIVER. JAMA. 1925;85(12):883–886. doi:10.1001/jama.1925.02670120021007
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