Updated: 2/28/2017

Sorbitol

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Snapshot
  • A 69-year-old man presents to your clinic with a chief complaint of changes in his vision.  He has a past medical history of diabetes mellitus type II and medication non-compliance.  The patient states that after a very large meal in which he consumed a family-sized bucket of chicken, a glass of maple syrup, and an entire wedding cake he noticed that his vision became very blurry.  In fact, he notes this happens every time he eats a large meal (sorbitol accumulation in the lens & lens swelling).
Overview
  • Pathway
    • alternative method of trapping glucose in the cell
      • tissues with sorbitol dehydrogenase
        • liver
        • ovaries
        • seminal vesicles
        • lens (at low level of activity)
      • tissues without sorbitol dehydrogenase
        • Schwann cells
        • retina
        • kidneys
    • note: galactose can also be converted to an aldose
      • see Galactose Metabolism topic
  • Clinical relevance
    • prolonged hyperglycemia
      • commonly caused by uncontrolled diabetes mellitus
      • pathophysiology
        • glucose enters cells and is converted to sorbitol
          • in tissues without sorbitol dehydrogenase or low levels of activity
            • sorbitol trapped in cell and is osmotically active
      • presentation
        • pathology directly linked to which tissues have aldose reductase but lack sorbitol dehydrogenase 
          • peripheral neuropathy
          • cataracts
          • retinopathy
        • all symptoms of chronic diabetes
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