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Conversion of a-ketoglutarate to succinyl-CoA
72%
399/553
Conversion of succinate to fumarate
3%
14/553
Condensation of acetyl-CoA with oxaloacetate to form citrate
9%
52/553
Conversion of fumarate to malate
16/553
Formation of oxaloacetate from malate
11%
63/553
Select Answer to see Preferred Response
This man with alcoholism has Wernicke's encephalopathy from thiamine deficiency. Thiamine is a necessary cofactor for the enzyme a-ketoglutarate dehydrogenase, which is involved in the conversion of a-ketoglutarate into succinyl CoA. Thiamine deficiency is common in alcoholism and those with malabsorption syndromes. If a thiamine deficient patient is given a glucose load, the demands of the citric acid cycle, specifically a-ketoglutarate dehydrogenase, will cause the patient's thiamine levels to drop further. Wernicke's encephalopathy results from low thiamine and is recognized by the triad of ACE: Ataxia, Confusion, and abnormal Eye movements. It usually resolves with administratin of thiamine. Incorrect Answers: Answers 2-4: These reactions do not have thiamine as a cofactor.
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