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This Concept Map, created with IHMC CmapTools, has information related to: Ethel II, pyruvate is being shuttled into the lactate cycle in order to handle the increased NADH production from the alcohol breakdown pyruvate->lactate high lactate levels, NADH contributing to High NADH/NAD+ ratio, low nutrient, glucose intake contributing to low potassium, liver portal hypertension prothrombin time/INR, low nutrient, glucose intake contributing to low calcium, cell damage, cell death, and eventually fibrosis leads to increased total bilirubin, Ethel Kardashian has alcoholism, fatty acid oxidation yielding Acetyl CoA, liver which can be measured by the presence of intracelllar enzymes such as elevated creatinine, alcoholism her diet consists of low nutrient, glucose intake, RBC production in the bone marrow which can contribute directly to High Mean Corpuscular Volume (MCV), macrocytic anemia (low RBC/hemoglobin), the body will then need to depend on other energy sources such as fatty acid oxidation, High NADH/NAD+ ratio stimulates fatty acid synthesis in the liver, ascites causing epigastric pain, acetyl CoA is converted to malonyl CoA which is converted palmitate via a series of reactions requiring NADPH, pyruvate is being shuttled into the lactate cycle in order to handle the increased NADH production from the alcohol breakdown this leads to a hypoglycemic state Contributing to the Confused State of Patient, Feeling Weak, amino acid catabolism yielding Acetyl CoA, increased vascular resistance within the liver from compression of vessels by regenerative nodules, fibrosis, and reduction of the sinusoidal bed, low nutrient, glucose intake mimics the glucagon high/insulin low state should stimulate gluconeogenesis, that these liver enzymes have been relased from hepatocytes (ALT more specific, AST more sensitive) due to cell damage, cell death, and eventually fibrosis