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NMT 06120

BIOCHEMISTRY

NTA Level 6 Facilitator’s Guide for


Diploma in Nursing

September 2013

United Republic of Tanzania


Ministry of Health and Social Welfare
Ministry of Health and Social Welfare
Department of Human Resources Development
Nursing Training Section
© Ministry of Health and Social Welfare 2013
Table of content
Acronyms …………………………………………………………………………………..ii
Goals and Objectives of the Training Manual ..........................................................................vi
Overall Goal for training manual .......................................................................................................vi
Objectives for training manual...........................................................................................................vi
Introduction vii
Module Overview .............................................................................................................................vii
Who is the Module For? ...................................................................................................................vii
How is the Module Organized? ........................................................................................................vii
How Should the Module be Used? ...................................................................................................vii
Session 1: Basic Concepts in Biochemistry ..........................................................................1
Session 2: Structure and Functions of Biomolecules ............................................................7
Session 3: Introduction to Metabolism................................................................................15
Session 4: Carbohydrates Metabolism ................................................................................21
Session 5: Metabolism of Proteins and Lipids ....................................................................27
Session 6: Body Fluids and Electrolytes .............................................................................31
Session 7: Concepts in Genetics in Promoting Health and Preventing Ill-Health ..............37
Session 8: Concepts in Genetics in Promoting Health and Preventing Ill-Health ..............43
Session 9: Metabolic Disease and Care of Patients with Electrolyte Imbalance ................49

NMT 06120 Biochemistry NTA Level 6, Semester 1


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Acronyms
LCD - Liquid Crystal Display

ATP – Adenosine triphosphate

ADP – Adenosine diphosphate

NAD - Nicotinamide adenine dinucleotide

CoA – Coenzyme A

FAD - Flavin adenine dinucleotide

TCA - Tricyclic acid

PKU – Phenylketonuria

NGT – Nasogastric Tube

DNA – Deoxyribonucleic acid

LDL – Low-density Lipoprotein

ECF – Extracellular fluid

ICF – Intracellular fluid

IWL - Insensible water loss

NMT 06120 Biochemistry NTA Level 6, Semester 1


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Acknowledgement

The development of the training manuals for Certificate and Diploma in Nursing (NTA Level
4 to 6) has been possible and accomplished through involvement of different stakeholders.
The Ministry of Health and Social Welfare (MoHSW) through the Director of Human
Resources Development sends sincere gratitude to the stakeholders including the
coordinating team (Department of Nursing and Midwifery Training), TNI, through AIHA and
the WINONA state University for funding the activity.

The MOHSW would like to thank all those involved during the process for their valuable
contribution to the development of these training materials. The ministry of Health would like
to thank the Assistant Director for Nursing Training section Mr. Ndementria Vermand, and
Ms. Vumilia B.E Mmari (Coordinator for Nursing and Midwifery Training) who tirelessly led
this important process.

Sincere gratitude is expressed to main facilitator: Mr. Golden Masika, Tutorial Assistant
University of Dodoma for his tireless efforts and Mr. Nicolaus Ndenzako Programme
consultant of AMCA inter consultant in guiding participants through the process. Special
thanks go to the team of contributors representing the Health Training Institutions, hospitals
and Universities. Their participation in meetings and workshops and their inputs in the
development of the content for each module have been invaluable. It is the commitment of
these participants that has made this product possible.

These participants are listed with our gratitude below:

SN Name Title Institution


1. Mary S. Matembo Nurse Tutor Korogwe NTC
2. Elialilia M. Herman Nurse Tutor MT. Meru Hospital
3. Alice Chifunda Nurse Tutor Mbulu NTC
4. Lilian Wilfreda Nurse Tutor KCMC
5. Aselina Milinga Nurse Tutor KCMC
6. Veronica Mahela Nurse Tutor Kahama
7. Samwel Mwangoka Nurse Tutor Mbeya SOTM
8. Hamza S. Matagira Nurse Tutor Kahama NTC
9. Elikana Wallace Nurse Tutor Kolandoto S/Nursing
10. Anna Sangito Pallangyo Nurse Tutor Kahama NTC
11. David Abincha Nurse Tutor Bukumbi NTC
12. Leon S. Mgohamwende Nurse Tutor Tosamaganga NTC
13. Crescent D. Ombay Nurse Tutor Haydom S/Nursing
14. Kizito B. Tamba Nurse Tutor Ndanda S/N
15. Robert E. Moshi Nurse Tutor IMTU college of Nursing
16. Oresta Ngahi Nurse Tutor Muhimbili S/N
17. Aloyce Ambokile Nurse Tutor Kondoa District Hosp.
18. Helma A. Shimbo Nurse Tutor Mwambani NTC
19. Elizabeth G. Chezue PNO N Tutor MOHSW HIS & QAS
20. Hinju Januarius Obstetrian Dodoma Regional Hosp.
21. Manase Nsunza Principal HLT Singida HLTC
22. Ezekiel Amata IMC Facilitator Mpwapwa Hosp.
23. Sostenes D. Ntambuto HLT Tutor SMLS MUHIMBILI
24. Anna Sangito Pallanyo N/Tutor Kahama SN
25. Naomi Kagya NT Muhimbili

NMT 06120 Biochemistry NTA Level 6, Semester 1


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26. Aloyce Amboikile Nurse Kondoa
27. Golden Masika Lecturer UDOM
28. Vumilia B.E. Mmari CD-NT MOHSW
29. Upendo kilume Nurse PHN
30. Fatuma Iddi Librarian MOHSW
31. Shango Nasania Nurse Newala
32. George Laisser C/Analyst MOHSW
33. Anande Mungure Nurse Tutor Mbulu NTC
34. Robert Masano Nurse Tutor Nkinga NTC
35. Ambokile Dodoma General Hospital
36. Nolasca Mtega Nurse Tutor Tukuyu School of Nursing
37. Asteria Ndomba Senior Lecturer CUHAS
38. Alfreda Ndunguru
39. Elizabeth Chezua MOHSW
40. Magwaza Charles
41. Ellen Mwandemele
42. Robert Mushi IMTU
43. Anna Mangula Nurse Tutor Mirembe NTC
44. Cesilia Mallya Nurse tutor Newala NTC
45. Helma Shimba
46. Kapaya Andrew TNMC
47. Ntambuto Sostenese
48. Joseph Nkungu
49. Anastazia Dinho
50. Eliaremisa Ayo Nurse Tutor MOHSW
51. Grace Mallya Paediatrician RCHS/GBV/VAC-MOHSW
52. Dr. Tecla Kohi Senior Lecturer MUHAS
53. Dr. Lilian Msele Lecturer MUHAS

Supporting staff:
Daniel Muslim Driver, Ministry of Health and Social Welfare
Fatuma Mohamed Health Librarian, Ministry of Health and Social Welfare
Mbaruku A. Luga Driver, Morogoro School of Public Health Nursing
Roselinda RugemaliraAdm. Secretary, Tanzania Nursing & Midwifery Council
Veronica Semhando Secretary Ministry of Health & Social Welfare
George Laizer System Analyst Ministry of Health & Social Welfare
Silvanus Ilomo System Analyst Ministry of Health & Social Welfare
Violet Mrema Adm. Secretary, Ministry of Health and Social Welfare
Walter Ndesanjo System Analyst, Ministry of Health and Social Welfare

Dr. Gozbert Mutahyabarwa


Ag: Director of Human Resource and Development,

NMT 06120 Biochemistry NTA Level 6, Semester 1


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Background

In 2007 the Ministry of Health and Social welfare (MOHSW) started the process of
reviewing the nursing curricula at Certificate and diploma level. In 2008 refined and
developed NTA Level 4 to 6 Nursing Curricula and in the same year 2008 started the
implementation. The intention was to comply with the National Council for Technical award
(NACTE) Qualification framework which offers a climbing ladder for higher skills
opportunity. Advanced Diploma awards are not among the awards of the council and do not
conform to NACTE framework. Therefore, institutions offering Advanced Diploma in
nursing are required to either offer Ordinary Diploma (NTA Level 6) or develop its capacity
to offer Bachelor’s Degree (NTA Level 7&8).

These programs have been developed in line with the above consideration aiming at
providing a room for Nurses to continue to a higher learning and achieve advanced skills
which will enable them to perform duties competently. In addition, WHO advocates for
skilled and motivated health workers in producing good health services and increase
performance of health systems (WHO World Health Report, 2006). Moreover, Primary
Health Care Development Program (PHCDP) (2007-15) needs the nation to strengthen and
expand health services at ALL levels. This can only be achieved when the Nation has
adequate, appropriately trained and competent work force who can be deployed in the health
facilities to facilitate the provisions of quality health care services.

In line with these new curricula, the MOHSW supported tutors by developing quality
standardized training materials to accompany the implementation of the developed curricula.
These training materials will address the foreseen discrepancies in the implementation of the
new curricula. NTA level 8 training materials have been developed after Curricula validation
and verification.

This training material has been developed through writers’ workshop (WW) model. The
model included a series of workshops in which tutors and content experts developed training
materials, guided by facilitators with expertise in instructional design and curriculum
development. The goals of Writer’s Workshop were to develop high-quality, standardized
teaching materials and to build the capacity of tutors to develop these materials. This product
is a result of a lengthy collaborative process, with significant input from key stakeholders
(NACTE, MOHSW, AIHA and WINONA University) and experts of different organizations
and institutions. The new training package for NTA Level 4-6 includes a Facilitator Guide
and Student Manual. There are 28 modules with approximately 520 content sessions

NMT 06120 Biochemistry NTA Level 6, Semester 1


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Rationale

The vision and mission of the National Health Policy in Tanzania focuses on establishing a
health system that is responsive to the needs of the people, and leads to improved health
status for all. Skilled and motivated health workers are crucially important for producing
good health through increasing the performance of health systems (WHO, 2006). With
limited resources (human and non-human resources), the MOHSW supported tutors by
developing standardized training materials to accompany the implementation of the
developed CBET curricula. These training manuals address the foreseen discrepancies in the
implementation of the new curricula.

Therefore, this training manual for Certificate and Diploma program in Nursing (NTA Levels
4-6) aims at providing a room for Nurses to continue achieving skills which will enable them
to perform competently. These manuals will establish conducive and sustainable training
environment that will allow students and graduates to perform efficiently at their relevant
levels. Moreover, this will enable them to aspire for attainment of higher knowledge, skills
and attitudes in promoting excellence in nursing practice.

Goals and Objectives of the Training Manual

Overall Goal for training manual


The overall goal of these training manual is to provide high quality, standardized and
competence-based training materials for Diploma in nursing (NTA level 4 to 6) program.

Objectives for training manual


 To provide high quality, standardized and competence-based training materials.
 To provide a guide for tutors to deliver high quality training materials.
 Enable students to learn more effectively.

NMT 06120 Biochemistry NTA Level 6, Semester 1


vi
Introduction
Module Overview
This module content has been prepared as a guide for tutors of NTA Level 6 e for training
students. The session contents are based on the sub-enabling outcomes of the curriculum of
NTA Level 6 Diploma in Nursing.
The module sub-enabling outcome as follows:
1.1.1 Explain the concepts of biochemistry in the provision of quality care
1.1.2 Explain the importance of genetics in promoting health and preventing ill-health
1.1.3 Utilize the knowledge of biochemistry and Genetics in provision of care

Who is the Module For?


This module is intended for use primarily by tutors of NTA Level 6 diploma in nursing
schools.
The module’ sessions give guidance on the time and activities of the session and provide
information on how to teach the session to students. The sessions include different activities
which focus on increasing students’ knowledge, skills and attitudes.

How is the Module Organized?


The module is divided into 9 sessions; each session is divided into sections. The following
are the sections of each session:
 Session Title: The name of the session.
 Learning Tasks – Statements which indicate what the student is expected to learn at the
end of the session.
 Session Content – All the session contents are divided into steps. Each step has a heading
and an estimated time to teach that step. Also, this section includes instructions for the
tutor and activities with their instructions to be done during teaching of the contents.
 Key Points – Each session has a step which concludes the session contents near the end
of a session. This step summarizes the main points and ideas from the session.
 Evaluation – The last section of the session consists of short questions based on the
learning objectives to check the understanding of students.
 Handouts are additional information which can be used in the classroom while teaching
or later for students’ further learning. Handouts are used to provide extra information
related to the session topic that cannot fit into the session time. Handouts can be used by
the participants to study material on their own and to reference after the session.
Sometimes, a handout will have questions or an exercise for the participants. The answers
to the questions are in the Facilitator Guide Handout, and not in the Student Manual
Handout.

How Should the Module be Used?


Students are expected to use the module in the classroom and clinical settings and during
self-study. The contents of the modules are the basis for learning Biochemistry. Students are
therefore advised to learn each session and the relevant handouts and worksheets during class
hours, clinical hours and self-study time. Tutors are there to provide guidance and to respond
to all difficulty encountered by students

NMT 06120 Biochemistry NTA Level 6, Semester 1


vii
NMT 06120 Biochemistry NTA Level 6, Semester 1
viii
Session 1: Basic Concepts in Biochemistry
Total Session Time: 120 Minutes

Prerequisites
 None

Learning Tasks
By the end of this session, students are expected to be able to:
 Define the terms: biochemistry, atom, molecule, compounds, acid, alkali and pH
 Illustrate the structure of the cell
 Explain the function of cell organelles

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Computer and LCD
 Overheard Projector
 Nutrient Cards

SESSION OVERVIEW
Step Time Activity/ Content
Method
1 05 Minutes Presentation Presentation of Session Title and Learning
Tasks
2 30 Minutes Presentation, Introduction, Definitions of Terms
Brainstorm
3 35 Minutes Presentation Cell Structure

4 40 Minutes Presentation Functions of Cell Organelles


Group Discussion
5 05 Minutes Presentation Key Points

6 05 Minutes Presentation Evaluation

SESSION CONTENT

Step 1: Presentation of Session Title and Learning Tasks (5 minutes)


READ or ASK the students to read learning task and clarify.

ASK students if they have any questions before proceeding.

NMT 06120 Biochemistry


NTA Level 6, Semester 1 1
Session 1 Basic Concepts in Biochemistry
Step 2: Introduction to Biochemistry (25 minutes)

 Biochemistry is the study of the chemistry, structure, properties and function of


biomolecules in living organisms.
 Simply defined as the chemistry of life (bio = life)
 Nutrition is multi-sectorial in nature; hence strategies to improve nutrition are multi-
sectorial as well. It therefore requires concerted efforts by all sectors to achieve better
nutrition.

Activity: Brainstorming (5 minutes)

ASK students to brainstorm on the definitions of atom, molecule, compound, electrolytes,


acid and alkali

ALLOW few students to provide responses allow others to provide unmentioned responses.

WRITE their responses on the black board or flip chart.

SUMMARIZE their responses using the information below.

Definitions of Terms
 Atom: Is the simplest unit of matter comprised of a central nucleus surrounded by
electrons
 Molecule: Is a combination of two or more atoms, which could be the same as in oxygen
(O2) or different as in water (H2O)
 Compound: Is a molecule that is formed by two different molecules, like water, which is
a molecule as well as a compound.
 Electrolytes: These are minerals found in body fluids including blood, which carry an
electric charge
o Examples of electrolytes found in the blood include: acids, bases, salts such as
potassium, sodium and bicarbonate
o Electrolytes in body fluids have to be maintained kept constant as they are required
for maintaining body fluids, blood pH and many body functions.
o Electrolytes are lost in the sweating; however, the loss can be replaced by drinking
fluids.
 Acid: An acid is a compound which when it dissolves in water it produces hydrogen ions
H+
o For example: Hydrochloric acid HCl (aq) ------H+(aq) + Cl-(aq)
 Alkali: Alkali is a compound which when it dissolves in water it produces hydroxide ions
OH-
o For example: Sodium hydroxide NaOH --------Na+(aq) + OH-(aq)
 pH
o pH is defined as a negative logarithymn of hydrogen ions.
o The pH below 7 is acidic, pH above 7 is alkaline whereas pH of 7 is considered
neutral
o Water which has a pH of 7, therefore is considered neither acidic nor alkali
o Human blood is slightly alkaline (pH 7.35-7.45). If the blood pH below or above this
range is abnormal

NMT 06120 Biochemistry


NTA Level 6, Semester 1 2
Session 1 Basic Concepts in Biochemistry
Step 3: Structure of the Cell (35 minutes)

 All living organisms are made up of the smallest unit of life called cells.
 In living organisms, the cell occupies a central position as the atom in physical science.
 Cells vary in shape and size; there are some which are spherical, oval, columnar and
irregular depending on the tissue and function it performs in a tissue.
 Plant cells differ from animal cells in that they have a cell wall, while animal cells do not.

Figure 1.1: Structure of a Cell

Source: McLaren, D. S. (1992

Table 1.1: The difference between eukaryotic cell and prokaryotic cell
S/N Eukaryotic cell Prokaryotic cell
1 Have nucleus No nucleus
2 Membrane-bound organelles Do not
3 Ten times larger Smaller
4 Have cell membrane Have cell wall

NMT 06120 Biochemistry


NTA Level 6, Semester 1 3
Session 1 Basic Concepts in Biochemistry
Step 4: Types and Functions of Cell Organelles (40 minutes)

 Cell organelles are small, specialised membrane-bound structures found in the cell, the
largest of which is the nucleus

Activity: Small Group Discussion (20 minutes)

DIVIDE students into small manageable groups.

PREPARE the nutrient cards by writing one of the following organelles on each card:
Cell membrane, Mitochondria, Endoplasmic reticulum, Golgi apparatus, Lissome and
Nucleus

PROVIDE organelle cards to each group so each has few cards.

ALLOW Groups to write down the function of the given cell organelles (above organelles)
for 5 minutes

ALLOW groups to present their responses in front of others for 1 minute each

SUMMARIZE the responses using the information given below

The functions of cell organelles

Organelle Function
Cell membrane Outer membrane of the cell
Controls movement of molecules , allowing selective passage of
molecules in and out of the cell
Mitochondria Second largest organelle
Double membrane with inner folding
Produces energy through chemical reactions breaking down
carbohydrates and lipids
Endoplasmic reticulum Site for the production of protein
Stores, and serves as a cell transport system
Golgi apparatus Protein packaging organelle
Excretion of cellular products
Lysosomes Digests proteins, carbohydrates and lipids
Transports undigested material to the cell membrane for removal.
Nucleus The largest organelle
Directs cell activities
Contain genetic material

Step 5: Key Points (5 minutes)

 Biochemistry is the study of chemistry of life


 The pH of blood is 7.35, which is slightly acidic

NMT 06120 Biochemistry


NTA Level 6, Semester 1 4
Session 1 Basic Concepts in Biochemistry
 Cell is the primary unit of life

Step 6: Evaluation (5 minutes)

 What is the meaning of the following terms: atom, molecule, electrolyte and pH
 What are the major functions of cell organelles?
 What is the difference between an animal cell and plant cell?

ASK students if they have any comments or need clarification on any points

References

 Harper P (2004). Practical Genetic Counseling. London. Arnold


 King, S. F. & Burgess, A. (2000). Nutrition for Developing Countries (2nd ed). USA:
Felicity Oxford University Press.
 Kumar, P. & Clark, M. (2006). Clinical Medicine (6th ed). USA: Elsevier Limited.
 Latham, M. C. (1997). Human Nutrition in the Developing World. David Lubin Memorial
Library.
 McLaren, D. S. (1992). A Color Atlas and Text of Diet-Related Disorders (2nd ed).
Aylesbury, England: BPCC Hazells Ltd.
 Tanzania Food and Nutrition Centre (2009). National Guidelines for Nutrition Care and
Support for People Living with HIV (2nd ed) Tanzania: TFNC
 The Human Genetic Society of Australia (HGSA) online. Available from:
httpwww.hgsa.com.au. (Accessed August, 2011).
 Wardlaw G.M. (2003). Contemporary Nutrition: Issues and Insights (4th ed). USA: Mc
Graw-Hill.
 Wardlaw, G.M. (2003). Contemporary Nutrition: Issues and Insights (5th ed). USA: Mc
Graw-Hill.

NMT 06120 Biochemistry


NTA Level 6, Semester 1 5
Session 1 Basic Concepts in Biochemistry
NMT 06120 Biochemistry
NTA Level 6, Semester 1 6
Session 1 Basic Concepts in Biochemistry
Session 2: Structure and Functions of Biomolecules
Total Session Time: 120 Minutes

Prerequisites
 None

Learning Tasks
By the end of this session, students are expected to be able to:
 Define carbohydrates, proteins and lipids
 Describe the structure and function of: carbohydrates, proteins and lipids
 Explain the importance of carbohydrates, proteins and lipids in the body

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Computer and LCD
 Handout 2.1: Structure of Amino Acids

SESSION OVERVIEW
Step Time Activity/ Method Content
1 05 Minutes Presentation Presentation of session Title and Learning
Tasks
2 15 Minutes Presentation, Definitions of Terms: Carbohydrates, Proteins
Brainstorm and Lipid
3 30 Minutes Presentation Structure and Functions of Carbohydrates

4 35 Minutes Presentation Structure and Functions of Proteins

5 25 Minutes Presentation Structure and Functions of Lipids


Group Discussion
6 05 Minutes Presentation Key Points

7 05 Minutes Presentation Evaluation

SESSION CONTENT

Step 1: Presentation of Session Title and Learning tasks (5 minutes)


READ or ASK the students to read learning task and clarify.

ASK students if they have any questions before proceeding.

NMT 06120 Biochemistry


NTA Level 6, Semester 1 7 Session 2: Structure and Functions of
Biomolecules
Step 2: Definition of Carbohydrates, Proteins and Lipids (15 minutes)

 Carbohydrates, proteins and lipids are the major biological molecules found in living
organisms.
 These macromolecules are involved in nearly all biological processes
 Understanding their structure and roles they play in humans in health and in disease is
important to a nurse.

Activity: Brainstorm (5 minutes)

ASK students to brainstorm on the definitions of lipids, proteins and lipids

ALLOW few students to provide responses.

WRITE their responses on the black board or flip chart.

SUMMARIZE their responses using the information below.

Definition of Terms:
 Carbohydrates: These are organic compounds made up of carbon, hydrogen and oxygen
which serve as the major source of fuel in living organisms
 Proteins: Are biological molecules made up of carbon, hydrogen, oxygen and nitrogen.
Some do contain phosphorus and sulphur
 Lipids:
o These are complex biological molecules made up of carbon, hydrogen and oxygen
that are highly insoluble in water but soluble in organic solvent.
o They are constituents of cell membranes

Step 3: Structure and Function of Carbohydrates (30 minutes)

 Carbohydrates are complex molecules made up of smaller units of building blocks called
monosaccharides (mono = one)
 The commonest monosaccharide is glucose

Table 2.1: Types of Monosaccharides

# of Carbons Name Examples

3 Triose Glyceraldehyde and Dihydroxyacetone


4 Tetrose Erythrose
5 Pentose Ribose, Ribulose, Xylulose
6 Hexose Glucose*, Galactose, Mannose, Fructose

NMT 06120 Biochemistry NTA Level 6, Semester 1


NTA Level 6, Semester 1 8 Session 2 Structure and Functions of
Biomolecules
 Glucose, a 6-C monosaccharide is the commonest monosaccharide

Structure of Monosaccharides
 Glucose in solution exists as 6-membered ring shown belowexists

Disaccharides
 Are formed when two monosaccharides are joined together
 The type of bond is called glycosidic bond
 The commonest disaccharides are:
o Maltose [glucose + glucose]
o Lactose [glucose = galactose]:
 Found only in milk

o Lactose [glucose = galactose]: Sucrose [glucose = fructose]


o Found in sugar care

Polysaccharides
 These are formed by many monosaccharide units joined together through glycosidic
bonds.
 The monosaccharides that serve as building blocks in a polysaccharide could be identical
or different.
o Polysaccharide made from identical monosaccharides are called
homopolysaccharides,
o If polysaccharide made from more than one monosaccharides are called
heteropolysaccharides divided into two major groups: macronutrients and
micronutrients.

Types of polysaccharides
 Glycogen
o Is the major storage form of glucose in animals
o In humans glycogen is found in the liver and muscles
o Is a homopolysaccharide of glucose,

NMT 06120 Biochemistry NTA Level 6, Semester 1


NTA Level 6, Semester 1 9 Session 2 Structure and Functions of
Biomolecules
o Is a highly branched polysaccharide

Starch
 This is the major type of sugar in plants
 Is a homopolymer of glucose, but unlike glycogen starch is less branched

Step 4: Structure and function of Proteins (35 minutes)

 Proteins are organic molecules that contain the elements carbon, hydrogen, oxygen and
nitrogen
 Proteins are present in large amounts in human body and perform many functions, but
they all share a common feature of being made by a set of only 20 amino acids in humans

Activity: Small Group Discussion (15 minutes)

DIVIDE students into small manageable groups

ALLOW the students in their respective groups to discuss the structure and function of
proteins

TELL the groups to present their responses to the class

FACILITATE the proper discussion of groups members responses

CONCLUDE by giving the proper functions as outlined below

Functions of Proteins
 Regulation of body metabolism: enzymes and hormones
 Movement: collagen in muscles
 Strength and support: collagen in bones
 Transport of essential molecules: transport of oxygen in blood by haemoglobin
 Protection against infection: antibodies against bacteria and viruses

Amino acids
 These are the building blocks of proteins
 Each amino acid has a carboxyl group (-COOH) and an amino group (-NH2) both
attached to the same carbon.
 Additionally, all amino acids have a distinctive side chain (R-group)
 There are only 20 amino acids found in proteins in humans.

Structure of amino acids


 Each of the 20 amino acids are different from one another by the side chain (R-group)
attached to the alpha-carbon.
 The characteristic and function of amino acid or proteins is determined by the nature of
the side chain R-group

Refer to Handout 2.1: Structure of Amino Acids

NMT 06120 Biochemistry NTA Level 6, Semester 1


NTA Level 6, Semester 1 10 Session 2 Structure and Functions of
Biomolecules
 Depending on the nature of the R-group, amino acids with a hydrophilic R-group repel
water and are termed hydrophilic amino acids, whereas amino acids with hydrophobic R-
group which repel water are called hydrophobic.
 Because of their hydrophobic (water hating) nature, hydrophobic amino acids are found
hidden in the interior of the protein voiding water, whereas hydrophilic (water-loving)
amino acids will be found in the outside the protein in contact with water.

Peptide bonds
 These are bonds that link one amino acid to another.
 The bond is formed by condensation reaction (where water is released) between one
carboxyl groups of one amino acid with an amino group of adjacent amino acid.
 A Dipeptide is the simplest peptide formed when two amino acids are joined together by
one peptide bond
 Proteins are polymers of hundreds and thousands of amino acids. (haemoglobin = 574
amino acids)
 Many proteins are made up of a single chain of amino acids joined together, some
however are made up of more than one chain (haemoglobin = 4 chains).

Example of Protein
 Haemoglobin
o A protein found only in red blood cells.
o Its function is to carry oxygen from the lungs to tissues, and carbon dioxide from
tissues back to the lungs.
o The human haemoglobin molecule in adults is made up of four chains;
 Two alpha chains (141 amino acids each), and
 Two beta chains (146 amino acids each)
o These chains are linked together by non covalent bonds
o Sickle cell disease is a genetic disease common in Tanzania, caused by an amino
acid substitution in the beta chain of haemoglobin, where amino acid glutamate is
replaced by valine.
o This change results in abnormal shape red blood cells and sickling when such
individuals are exposed to environment with low oxygen.

Step 5: The Structure and Function of Lipids: (25 minutes)

 Lipids are complex biomolecules which are diverse in structure as well as function
 They comprise the largest store of energy in the body
 Lack of lipids or lipid deficiency or imbalances results in serious diseases like diabetes
mellitus and atherosclerosis, a disease causing blocking of blood vessels.
 Lipids consists of ;
o Triacylglycerols
o Cholesterol
o Phospholipids
o Free fatty acids

Structure of Fatty Acids


 These are long chain of hydrocarbons, with a carboxyl group attached at the end

Classification of Fatty acids

NMT 06120 Biochemistry NTA Level 6, Semester 1


NTA Level 6, Semester 1 11 Session 2 Structure and Functions of
Biomolecules
 Non-Essential fatty Acids
o These fatty acids can be synthesized in the body
 Essential fatty acids
o These are fatty acids which must be obtained in the diet.
o The two essential fatty acids which are precursors of prostaglandins are:
 Linoleic acid
 Linoleic acid

Functions of Lipids
 Major source of energy for the body
 Components of cell membrane
 Control of body functions - hormones

Step 6: Key Points (5minutes)

 Carbohydrates, proteins and lipids are the major biological molecules in living organisms.
 These macromolecules play functions in living organisms, including energy, movement,
protection and transport.
 These macromolecules are built from simple monomers, with link together to form
complex macromolecules.

Step 7: Evaluation (5 minutes)

 What are the major functions of carbohydrates and lipids?


 What are the major functions of proteins?
 What is the difference between starch and glycogen?
 Explain the structure of hemoglobin

ASK students if they have any comments or need clarification on any points.

References

 Harper P (2004). Practical Genetic Counseling. London. Arnold


 King, S. F. & Burgess, A. (2000). Nutrition for Developing Countries (2nd ed). USA:
Felicity Oxford University Press.
 Kumar, P. & Clark, M. (2006). Clinical Medicine (6th ed). USA: Elsevier Limited.
 Latham, M. C. (1997). Human Nutrition in the Developing World. David Lubin Memorial
Library.
 McLaren, D. S. (1992). A Color Atlas and Text of Diet-Related Disorders (2nd ed).
Aylesbury, England: BPCC Hazells Ltd.
 Tanzania Food and Nutrition Centre (2009). National Guidelines for Nutrition Care and
Support for People Living with HIV (2nd ed) Tanzania: TFNC
 The Human Genetic Society of Australia (HGSA) online. Available from:
httpwww.hgsa.com.au. (Accessed August, 2011).
 Wardlaw G.M. (2003). Contemporary Nutrition: Issues and Insights (4th ed). USA: Mc
Graw-Hill.
 Wardlaw, G.M. (2003). Contemporary Nutrition: Issues and Insights (5th ed). USA: Mc
Graw-Hill.

NMT 06120 Biochemistry NTA Level 6, Semester 1


NTA Level 6, Semester 1 12 Session 2 Structure and Functions of
Biomolecules
Handout 2.1: Structure of Some Common Amino Acids

Amino Acid Symbol Structure

Common amino acids

Glycine Gly – G

Alanine Ala – A

Valine Val – V

Leucine Leu – L

Isoleucine Ile – I

NMT 06120 Biochemistry NTA Level 6, Semester 1


NTA Level 6, Semester 1 13 Session 2 Structure and Functions of
Biomolecules
NMT 06120 Biochemistry NTA Level 6, Semester 1
NTA Level 6, Semester 1 14 Session 2 Structure and Functions of
Biomolecules
Session 3: Introduction to Metabolism
Total Session Time: 120 Minutes

Prerequisites
 None

Learning Tasks
By the end of this session, students are expected to be able to:
 Define Metabolism, catabolism and anabolism
 Classify metabolic pathways
 Explain metabolic regulation
 Relate thermodynamics and metabolism

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Computer and LCD

SESSION OVERVIEW
Activity/
Step Time Content
Method
1 05 Minutes Presentation Presentation of Session Title and Learning Tasks
Presentation
2 10 Minutes Definition of Terms
Buzz
3 20 Minutes Presentation Classification of Metabolic Pathways

4 30 Minutes Presentation Regulation of Metabolic Pathways

5 45 Minutes Presentation Thermodynamics and Metabolism

6 05 Minutes Presentation Key Points

7 05 Minutes Presentation Evaluation

SESSION CONTENT

Step 1: Presentation of Session Title and Learning tasks (5 minutes)


READ or ASK the students to read learning task and clarify.

ASK students if they have any questions before proceeding.

NMT 06120 Biochemistry


NTA Level 6, Semester 1 15
Session 3: Introduction to Metabolism
Step 2: Definition of Terms (10 minutes)

Activity: Buzzing (5 minutes)

ASK students to buzz in pairs and define the terms Metabolism, Catabolism and Anabolism.

ALLOW three to four pair of students to provide responses and let others provide
unmentioned responses

SUMMARIZE the responses using the content below.

Metabolism
 Metabolism is defined as the sum of all chemical reactions in living organisms
 Metabolism is a central theme in biochemistry
 Metabolism is divided into catabolic and anabolic reactions

Catabolism
 Refers to reactions which degrade (breaks-down) macromolecules (complex molecules)
to simple compounds to release energy.
 Example:
o Breakdown of glucose in presence of oxygen to carbon dioxide and water

Anabolism
 Are reactions which synthesize (manufacture) macromolecules from simple compounds
required for the growth of cells, reproduction and repair.
 Anabolic pathways consume energy
 Example:
o The synthesis of proteins from amino acids

Step 3: Classification of Metabolic Pathways (20 minutes)

Classification of Metabolism
 One way of classifying metabolism is that based on the biomolecules involved where you
can divide them into four major groups
o Metabolism of Carbohydrates
o Metabolism of Lipids
o Metabolism of amino acids (proteins), and
o Metabolism of nucleotides
 Each group comprises of a set of individual pathways

Types of Metabolic Pathways


 Linear pathways
o In this type, the product of one reaction is a substrate of the next reaction
 Cyclic pathways
o The intermediates are regenerated, as in the Tri-carboxylic acid cycle
 Spiral
o Some of the enzymes in the pathway catalyze more than one reaction
o E.g. Fatty acid synthesis

NMT 06120 Biochemistry NTA Level 6, Semester 1


NTA Level 6, Semester 1 16
Session 3 Introduction to Metabolism
Why do Metabolic Pathways Involve many Reaction Steps?
 In order to control the amount of energy input and produced.
 Allows step-wise transfer of energy from one intermediate to another,
 Enzymes usually catalyze one chemical reaction
 Many steps allows introduction of control points

Step 4: Regulation of Metabolic Pathways (30 minutes)

 Metabolic pathways are regulated through the following mechanisms:

Feedback Inhibition Mechanism


 The end product in the pathway controls its production
 The control point is usually the first step in the pathway

E1 E2 E3 E4
V -------- W ----------X ---------- Y ----------- Z
 For example - If the end product Z, in the reaction above inhibits E1, the enzyme
catalyzing the first reaction
 This mechanism is important in that it prevents wasteful production of intermediate

Positive Feedback
 The intermediate produced early in the pathway speeds the activity of an enzyme later in
the pathway

E1 E2 E3 E4
V -------- W ----------X ---------- Y ----------- Z

 For example - Intermediate W stimulated enzyme E4

Allosteric mechanism
 Allosteric regulation is the regulation of an enzyme or other protein by binding an
effector Cmolecule at the protein's allosteric site (that is, a site other than the protein's
active site).
 Effectors that enhance the protein's activity are referred to as Allosteric activators,
whereas those that decrease the protein's activity are called Allosteric inhibitors

Covalent modification
 The covalent attachment of another molecule can modify the activity of enzymes and
many other proteins.
 In these instances, a donor molecule provides a functional moiety that modifies the
properties of the enzyme. Most modifications are reversible

Step 5: Thermodynamics and Metabolism Regulation (45 minutes)

 Depending on energy requirements, metabolic reactions are classified into:


Endergonic Reactions
 Is the reaction that require a net input of energy in order to proceed

NMT 06120 Biochemistry NTA Level 6, Semester 1


NTA Level 6, Semester 1 17
Session 3 Introduction to Metabolism
 These reactions do not occur spontaneously
Exergonic Reaction
 Are reactions which generates net energy and
 Proceeds spontaneously
Free Energy Change
 Free energy change (dG) is a measures of energy present to drive a chemical reaction.
dG = dG of productss - dG of reactants
 If dG is negative, the reaction takes place spontaneously, and no extra energy is required
to drive the reaction (exergonic)
 However, if dG is positive, energy must be provided for the reaction to proceed
(endergonic).

How Can an Endergonic Metabolic Reaction (Reaction with a +dG Made to Proceed?
 By coupling a reaction with a positive dG to a reaction with a negative dG, (endergonic to
exergonic reaction) such as the hydrolysis of ATP.

ATP ----------- ADP + Pi dG = -13 kcal/mol

 For example, consider coupling an endergonic (+dG) reaction to an exergonic reaction


such as ATP hydrolysis as shown below:

X ------- Y dG + +9.2 kcal/mol


ATP ------- ADP + Pi dG = -13.0 kcal/mol
X + ATP ------- Y + ADP + Pi dG = -3.8 kcal/mol

 Therefore an endergonic reaction converting X to Y which would not have happened


spontaneously, is now driven by coupling to an exergonic reaction

Step 6: Key Points (5minutes)

 Metabolism is the sum of all chemical reactions in living organisms


 Metabolic pathways are controlled through specific mechanisms in order to prevent
wasteful production of biomolecules
 Reactions which cannot proceed spontaneously could be driven if linked (coupled) with
energy releasing (exergonic) reactions

Step 7: Evaluation (05 minutes)

 What is metabolism?
 How are metabolic pathways regulated
 What are the coupling of reactions

ASK students if they have any comments or need clarification on any points.

NMT 06120 Biochemistry NTA Level 6, Semester 1


NTA Level 6, Semester 1 18
Session 3 Introduction to Metabolism
References

 Harper P (2004). Practical Genetic Counseling. London. Arnold


 King, S. F. & Burgess, A. (2000). Nutrition for Developing Countries (2nd ed). USA:
Felicity Oxford University Press.
 Kumar, P. & Clark, M. (2006). Clinical Medicine (6th ed). USA: Elsevier Limited.
 Latham, M. C. (1997). Human Nutrition in the Developing World. David Lubin Memorial
Library.
 McLaren, D. S. (1992). A Color Atlas and Text of Diet-Related Disorders (2nd ed).
Aylesbury, England: BPCC Hazells Ltd.
 Tanzania Food and Nutrition Centre (2009). National Guidelines for Nutrition Care and
Support for People Living with HIV (2nd ed) Tanzania: TFNC
 The Human Genetic Society of Australia (HGSA) online. Available from:
httpwww.hgsa.com.au. (Accessed August, 2011).
 Wardlaw G.M. (2003). Contemporary Nutrition: Issues and Insights (4th ed). USA: Mc
Graw-Hill.
 Wardlaw, G.M. (2003). Contemporary Nutrition: Issues and Insights (5th ed). USA: Mc
Graw-Hill.

NMT 06120 Biochemistry NTA Level 6, Semester 1


NTA Level 6, Semester 1 19
Session 3 Introduction to Metabolism
NMT 06120 Biochemistry NTA Level 6, Semester 1
NTA Level 6, Semester 1 20
Session 3 Introduction to Metabolism
Session 4: Carbohydrates Metabolism
Total Session Time: 120 Minutes

Prerequisites
 None

Learning Tasks
By the end of this session, students are expected to be able to:
 Explain the difference between anaerobic and aerobic glycolysis
 Describe the Citric acid cycle
 Explain the significance gluconeogenesis and pentose phosphate pathways

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Computer and LCD
 Handout 4.1: The Citric Acid Cycle

SESSION OVERVIEW
Step Time Activity/Method Content
Presentation of Session Title and Learning
1 05 Minutes Presentation
Tasks
Presentation,
2 10 Minutes Definition of Terms
Buzz
3 20 Minutes Presentation Glycolysis

4 25 Minutes Presentation Gluconeogenesis

5 35 Minutes Presentation The Citric acid Cycle

6 15 Minutes Presentation The Pentose Phosphate Pathway

7 05 Minutes Presentation Key Points

8 05 Minutes Presentation Evaluation

SESSION CONTENT

Step 1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before proceeding

NMT 06120 Biochemistry


NTA Level 6, Semester 1 21
Session 4: Carbohydrates Metabolism
Step 2: Definitions of Terms (10 minutes)

Activity: Buzzing (5 minutes)

ASK students in pairs to buzz the definition of the terms Metabolism, Catabolism and
Anabolism.

ALLOW three to four students to provide responses and let others provide unmentioned
responses

WRITE their responses on the flipchart/board

SUMMARIZE the responses using the content below.

 Metabolism is defined as the sum of all chemical reactions in living organisms


o Metabolism is a central theme in biochemistry
o Metabolism is divided into catabolic and anabolic reactions
 Catabolic reactions refer to reactions which degrade (breaks-down) macromolecules
(complex molecules) to simple compounds to release energy.
 Example: Breakdown of glucose in presence of oxygen to carbon dioxide and water
 Anabolic reactions synthesize (manufacture) macromolecules from simple compounds
required for the growth of cells, reproduction and repair.
o Anabolic pathways consume energy
o Example: synthesis of proteins from amino acids

Step 3: Glycolytic Pathway (20 minutes)

Activity: Brainstorming (10 minutes)

ASK students to brainstorm answers for the question: In which way can the body produce
energy from glucose?

ALLOW time for students to brainstorm

ALLOW few students to provide their responses, and others to add up if they have different
responses

WRITE their answers on flip chart/black board

PROVIDE answers using notes below

The Glycolytic Pathway


 Glycolysis literally means the splitting of sugar (glyco = sugar, lysis + splitting)
 The simplest pathway for energy production from glucose, resulting in net production of
two ATP per glucose.
 Occur in all cells
 Is a 10-step pathway converting Glucose ------ Pyruvate
 Products are: pyruvate, ATP and NADH
o In the absence of oxygen (anaerobic) the end product is Lactate

NMT 06120 Biochemistry NTA Level 6, Semester 1


NTA Level 6, Semester 1 22
Session 4 Carbohydrates Metabolism
o If oxygen is available (aerobic), pyruvate is further metabolised to carbon dioxide
and water.
o Net ATP yield is 38 per glucose
 The 6-C sugar glucose id=s split into two 3_C compounds in the 4th step
 The two 3_C molecules are in step 6 oxidized, reducing NAD
 ATP are generated in steps 7 and 10
 At the beginning glucose is twice phosphorylated,

Step 4: Gluconeogenesis (25 minutes)

Definition of Gluconeogenesis
 Gluconeogenesis is defined as the synthesis of glucose from simple compounds such as
lactate and pyruvate
 The ability to self-produce glucose is important as we do not eat all the time, therefore
this pathway is important for producing glucose at times of starvation or in between meals
 Many reactions in this pathway use the same enzymes as glycolyis
 There is a fine balance between the two opposing pathways, i.e. glycolyisis which breaks
glucose and gluconeogenesis which produces glucose from simpler molecules such as
pyruvate
 Typically the body ensures that the two opposing pathways are not active at the same
time in the cell
 The reason is such futile cycling will be wasteful of energy

Step 5: The Citric Acid Cycle (35 minutes)

 Also is also known is tri-carboxylic acid cycle or Krebs cycle


General Features of the Citric Acid Cycle
 Enzymes in citric acid cycle are found in the mitochondria matrix
 The pathways is both anabolic as well as catabolic (amphibolic)
 Intermediates are not phosphorylated

Key Reactions
Pyruvate dehydrogenase (PDH) reaction
 Is the entry point into the TA cycle
 Converts pyruvate to acetyl CoA through oxidative decarboxylation
 Is a complex reaction involving four separate reactions
 Inhibited by ATP, and NADH
 Citrate synthesis
o A condensation reaction (releases water) between acetyl CoA and aoxaloacetate to
produce citrate
o Inhibited by ATP and NADH
 Isocitrate dehydrogenase
o Oxidatively decarboxylates (releases CO2 and NADH)
o Produces a-ketoglutarate (5C)
o Inhibited by ATP and NADH
o Activated by ADP and NAD+
 Alpha ketoglutarate Dehydrogenase Complex

NMT 06120 Biochemistry NTA Level 6, Semester 1


NTA Level 6, Semester 1 23
Session 4 Carbohydrates Metabolism
o Is a complex reaction similar to PDH
o Oxidatively decarboxylates produces CO2 and NADH
The rest of the reactions in the cycle ends up regenerating oxaloacetate for the first reaction.
 Further reactions:
o One FADH and NADH are produced
o GTP is formed in step 5

Anabolic Functions of the TCA cycle


 The citric acid cycle serves as a source of many intermediates in metabolism including:
o Amino acid metabolism
o Fatty acid and cholesterol metabolism
o Gluconeogenesis

Refer Student to Handout 3.1 Citric acid cycle and discuss it with them

Step 6: Other Carbohydrate Metabolic Pathways (15 minutes)

 Other carbohydrates metabolic pathways include; pentose phosphate pathway and


glycogen metabolism.

The Pentose Phosphate Pathway


 This pathway serves two major roles:
o Produces NADPH, a reducing factor required in
Synthesis of fatty acids
Detoxifying peroxides and oxygen radicals, if deficient leads to rupture of
red blood cells and anaemia
o Generates Ribose-5-Phosphate
 This is a 5-C sugar for synthesis of nucleic acids

Step 7: Key Points (05 minutes)

 Glycolysis is a universal pathway which takes place in both aerobic and anaerobic
conditions in all cells
 The citric acid cycle take place in the mitochondria matrix, and produces large amounts
of energy in form of ATP
 Glycogenesis produces glucose from simpler molecules such as lactate and pyruvate

Step 8: Evaluation (05 minutes)

 What is the difference between glycolysis in anaerobic and aerobic conditions?


 Why are gluconeogenesis and pentose phosphate pathways important?
 List advantages of citric acid cycle

ASK students if they have any comments or need clarification on any points.

NMT 06120 Biochemistry NTA Level 6, Semester 1


NTA Level 6, Semester 1 24
Session 4 Carbohydrates Metabolism
References

 Harper P (2004). Practical Genetic Counseling. London. Arnold


 King, S. F. & Burgess, A. (2000). Nutrition for Developing Countries (2nd ed). USA:
Felicity Oxford University Press.
 Kumar, P. & Clark, M. (2006). Clinical Medicine (6th ed). USA: Elsevier Limited.
 Latham, M. C. (1997). Human Nutrition in the Developing World. David Lubin Memorial
Library.
 McLaren, D. S. (1992). A Color Atlas and Text of Diet-Related Disorders (2nd ed).
Aylesbury, England: BPCC Hazells Ltd.
 Tanzania Food and Nutrition Centre (2009). National Guidelines for Nutrition Care and
Support for People Living with HIV (2nd ed) Tanzania: TFNC
 The Human Genetic Society of Australia (HGSA) online. Available from:
httpwww.hgsa.com.au. (Accessed August, 2011).
 Wardlaw G.M. (2003). Contemporary Nutrition: Issues and Insights (4th ed). USA: Mc
Graw-Hill.
 Wardlaw, G.M. (2003). Contemporary Nutrition: Issues and Insights (5th ed). USA: Mc
Graw-Hill.

NMT 06120 Biochemistry NTA Level 6, Semester 1


NTA Level 6, Semester 1 25
Session 4 Carbohydrates Metabolism
Handout 4.1: The Citric Acid Cycle

 The citric acid cycle — also known as the tricarboxylic acid cycle (TCA cycle), the
Krebs cycle, or the Szent-Györgyi-Krebs cycle is a series of chemical reactions which is
used by all aerobic living organisms to generate energy through the oxidization of acetate
derived from carbohydrates, fats and proteins into carbon dioxide and water.
 In addition, the cycle provides precursors for the biosynthesis of compounds including
certain amino acids as well as the reducing agent NADH that is used in numerous
biochemical reactions.
 Its central importance to many biochemical pathways suggests that it was one of the
earliest established components of cellular metabolism and may have originated
abiogenically
 The name of this metabolic pathway is derived from citric acid (a type of
tricarboxyliccycle) which is first consumed and then regenerated by the pathway to
complete the cycle.
 In addition, the cycle consumes acetate in the form of acetyl-CoA, reduces NAD+ to
NADH, and produces carbon dioxide.
 The NADH generated by the TCA cycle is fed into the phospholylation pathway.
 The net result of these two closely linked pathways is the oxidation of nutrients to
produce energy in the form of ATP.
 In eukaryotic cells, the citric acid cycle occurs in the matrix of the mitochondrion.
Bacteria also use the TCA cycle to generate energy, but since they lack mitochondria, the
reaction sequence is performed in the cytosol

NMT 06120 Biochemistry NTA Level 6, Semester 1


NTA Level 6, Semester 1 26
Session 4 Carbohydrates Metabolism
Session 5: Metabolism of Proteins and Lipids
Total Session Time: 60 Minutes

Prerequisites
 None

Learning Tasks
By the end of this session, students are expected to be able to:
 Explain the difference between essential and non-essential amino acids
 Explain the significance of protein metabolism
 Describe the importance of fatty acids and cholesterol metabolism

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Computer and LCD
 Handout 5.1: Transamination and Oxidative Deamination
 Handout 5.2: The Urea Cycle

SESSION OVERVIEW
Activity/
Step Time Content
Method
1 05 Minutes Presentation Presentation of Session Title and Learning Tasks
Presentation,
2 10 Minutes Definition of Terms
Buzz
3 20 Minutes Presentation Protein Metabolism

4 15 Minutes Presentation Lipid Metabolism

5 05 Minutes Presentation Key Points

6 05 Minutes Presentation Evaluation

SESSION CONTENT

Step 1: Presentation of Session Title and Learning tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before proceeding

NMT 06120 Biochemistry


NTA Level 6, Semester 1 27 Session 5: Metabolism of Proteins and
Lipids
Step 2: Definitions of Terms (10 minutes)

Activity: Buzzing (5 minutes)

ASK students to be in pairs of 2 and buzz the significance of Protein, Fatty Acid and
Cholesterol Metabolism

ALLOW three to four students to provide responses.

SUMMARIZE the responses using the content below.

Protein Metabolism
 Involves all pathways involved in the synthesis and catabolism of amino acids, including
the disposal of ammonia as urea

Fatty Acid metabolism


 These include the pathways involved in the synthesis of fatty acids and breakdown of
fatty acids to release energy

Cholesterol Metabolisms
 Includes all metabolic processes involved in the production, transport and disposal of
cholesterol in the body

Step 3: Protein Metabolism (20 minutes)

Activity: Brainstorming (10 minutes)


ASK students to brainstorm for two minutes on what are essential amino acids

ALLOW few students to provide their responses and let others provide unmentioned
responses

WRITE their answers on flip chart/black board

PROVIDE answers using notes below

Synthesis of Amino Acids


 Depending on the ability of the body to produce amino acids, the amino acids are
classified into two main groups:

Essential Amino Acids


 These amino acids which can not be synthesized in the body, therefore they have to be
taken in the diet
 These have to be taken in the diet because there are no enzymes to produce them
 Example: amino acid histidine

NMT 06120 Biochemistry NTA Level 6, Semester 1


NTA Level 6, Semester 1 28
Session 5 Metabolism of Proteins and Lipids
Non-Essential Amino Acids
 These amino acids which can be synthesized in the body, therefore they are not strictly
essential to be taken in the diet
 Example, amino acid glycine

Breakdown of Amino Acids


 The catabolism of amino acids involves two key steps:
o Removal of the amino group to release ammonia
o Further breakdown of the remaining carbon skeleton to either citric acid or
gluconeogenesis intermediates
 The Removal of the Amino Group is by
o Transamination reactions
o These are reactions involving the removal of the amino group from amino
o Acid by transminase group of enzymes including:
 Alanine aminotransferase and
 Aspartate amino transferase
 Glutamate dehydrogenase
o This enzyme removes amino group from amino acid glutamate
o Releasing ammonia in the process

Refer Student to Handout 5.1: Transamination and Oxidative Deamination

Ammonia is Toxic
 The ammonia which is released is highly toxic to the brain
 In the body, ammonia is converted to urea, a non-toxic form in the urea cycle

The Urea Cycle


 Is a cycle which takes place in the liver
 The role to convert ammonia to urea, which is non-toxic, excreted by kidneys in urine
 Carbamoyl phosphate synthetase is the key enzyme in the cycle
 Babies born with defect in this enzyme die because they cannot convert ammonia to urea,
resulting in excessive accumulation of the toxic ammonia

Catabolism of Phenylalanine as an Example


 The first reaction in catabolism of phenylalanine is catalyzed by enzyme phenylalanine
hydroxylase to form tyrosine.
 Deficiency of this enzyme leads to a disease called phenylketonuria (PKU)

Refer Student to Handout 5.2: Urea Cycle

Step 4: Metabolism of Fatty Acids (15minutes)

Synthesis of Fatty Acids


 Takes place in the cytoplasm of liver and mammary gland cells
 Fatty acids are synthesized from acetyl CoA (2-C), ATP and NADPH
 This pathway is regulated by acetyl CoA carboxylase enzyme which is activated by
hormone insulin, and inactivated by glucagon and adrenaline
Fatty Acid Breakdown

NMT 06120 Biochemistry NTA Level 6, Semester 1


NTA Level 6, Semester 1 29
Session 5 Metabolism of Proteins and Lipids
 Pathway takes place in mitochondria of nearly all cells
 Produces a lot of energy
 Fatty acids are degraded step-wise, and in each step, into:
o Acetyl CoA, (2-C), which enters into the citric acid cycle, producing energy
o NADH,
o FADH and
o CO2
 NADH, and FADH transfer electrons in the eletron chain resulting in the formation of 3
and 2 ATPs respectively

Step 5: Key Points (05 minutes)

 Although proteins are not primary fuel molecules, catabolism of amino acids as in
starvation may produce energy
 Catabolism of amino acids is associated with production of ammonia, which is converted
to a non-toxic of urea.
 Catabolism of fatty acids releases highest amount of energy

Step 6: Evaluation (05 minutes)

 Can amino acids serve as fuel molecules?


 How is ammonia disposed in humans
 What is the difference between glycolysis in anaerobic and aerobic conditions?
 Why are gluconeogenesis and pentose phosphate pathways important?
 What are the advantages of citric acid cycle

ASK students if they have any comments or need clarification on any points.

References

 Harper P (2004). Practical Genetic Counseling. London. Arnold


 King, S. F. & Burgess, A. (2000). Nutrition for Developing Countries (2nd ed). USA:
Felicity Oxford University Press.
 Kumar, P. & Clark, M. (2006). Clinical Medicine (6th ed). USA: Elsevier Limited.
 Latham, M. C. (1997). Human Nutrition in the Developing World. David Lubin Memorial
Library.
 McLaren, D. S. (1992). A Color Atlas and Text of Diet-Related Disorders (2nd ed).
Aylesbury, England: BPCC Hazells Ltd.
 Tanzania Food and Nutrition Centre (2009). National Guidelines for Nutrition Care and
Support for People Living with HIV (2nd ed) Tanzania: TFNC
 The Human Genetic Society of Australia (HGSA) online. Available from:
httpwww.hgsa.com.au. (Accessed August, 2011).
 Wardlaw G.M. (2003). Contemporary Nutrition: Issues and Insights (4th ed). USA: Mc
Graw-Hill.
 Wardlaw, G.M. (2003). Contemporary Nutrition: Issues and Insights (5th ed). USA: Mc
Graw-Hill.

NMT 06120 Biochemistry NTA Level 6, Semester 1


NTA Level 6, Semester 1 30
Session 5 Metabolism of Proteins and Lipids
Session 6: Body Fluids and Electrolytes
Total Session Time: 120 Minutes

Prerequisites
 None

Learning Tasks
By the end of this session, students are expected to be able to:
 Define osmosis, diffusion and electrolytes
 List factors affecting water and electrolyte distribution
 Describe the types and sources and symptoms of deficiency of nutrients
 Explain the distribution pf body fluids and electrolytes
 Describe causes and examples of electrolytes and imbalances

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Computer and LCD

SESSION OVERVIEW
Step Time Activity/Method Content
Presentation of Session Title and Learning
1 05 Minutes Presentation
Tasks
Presentation, Definition of Osmosis, Diffusion and
2 15 Minutes
Buzz Electrolytes
3 30 Minutes Presentation Distribution of Body Fluids and Electrolytes
Presentation, Factors Affecting Distribution of Body Fluids
4 30 Minutes
Group Discussion and Electrolyte
Presentation, Identification of Patients with Fluid and
5 30 Minutes
Group Discussion Electrolyte Imbalance
6 05 Minutes Presentation Key Points
7 05 Minutes Presentation Evaluation

SESSION CONTENT

Step 1: Presentation of Session Title and Learning Tasks (05 minutes)


READ or ASK the students to read the learning tasks and clarify

ASK students if they have any questions before proceeding

NMT 06120 Biochemistry


NTA Level 6, Semester 1 31
Session 6: Body Fluids and Electrolytes
Step 2: Introduction and Definition of Osmosis, Diffusion and Electrolytes
(15 minutes)

 Body water and Electrolytes play a critical role in the wellbeing of living organisms
 Water, for example is required as:
o Sodium (Na+)
o Universal solvent for the nutrients
o Transport nutrients in the body
o Maintain shape and size in cells
o Lubricant in joints
o Cushion body organs

Table 6.1: Daily Body Fluid Intake in Adults

Sources and Daily Amount of Fluid Intake


Ingested Liquids 1,500 mL
Water in Food 700 mL
Water from oxidation (chemical reactions) 200 mL
Total 2,400 mL

 Electrolytes on the other hand are required by our bodies in order to perform the
following key functions:
o Promote muscle and nerves activity
o Tissue growth and repair
o Building and strengthening of bones
o Maintain body fluid volume and osmolarity
o Distribute body water between fluid compartments
o Regulation of acid base balance

Activity: Buzzing (5 minutes)

ASK students to pair up and buzz on the following questions:


 Define Osmosis, Diffusion and Electrolytes
 List examples of Electrolytes

ALLOW few students to respond and let others provide unmentioned responses.

PROVIDE clarification using notes below.

Definition of Terms
Osmosis
 This is a process of moving water from an area of low solute concentration to an area of
high solute concentration through a semi permeable membrane.
 As a result, water moves from a dilute compartment to a concentrated compartment.

NMT 06120 Biochemistry


NTA Level 6, Semester 1 32
Session 6: Body Fluids and Electrolytes
Diffusion
 Refers to the movement of substances from an area of higher concentration to an area of a
lower concentration

Electrolytes
 Compounds which when dissolved in water forms ions (charged particles).
 The main electrolytes in the body include:
o Potassium (K+)
o Sodium (Na+)
o Calcium (Ca+)
o Magnesium (Mg+)
o Bicarbonate (HCO3-)
o Chloride (Cl-)
o Phosphate (PO3-)

Step 3: Distribution of Body Fluids and Electrolytes (30 minutes)

 Between 45 to 75% of the total body weight is water, and about two thirds of this water is
inside cells (Intracellular)
 The amount of water in different tissues varies considerably.
 For example, muscles are 70% water, whereas, fats in the body are water free.
 Therefore the amount of water in a thin person is much higher than in an obese person.

Table 6.2: Distribution of Electrolytes in Body Fluids

Electrolyte Extracellular (m/Eq/L) Intracellular (mEq/L)


Sodium 140 10
Potassium 3-5 150-160
Calcium 8-10 5-10
Magnesium 1.3-2.1 35
Chloride (Cl-) 98-106 1-4
Bicarbonate (HCO3-) 25-27 10-12
Phosphate (HPO4-) 1.7-4.6 100-104
Sulphate (SO4-) 1 2

NMT 06120 Biochemistry


NTA Level 6, Semester 1 33
Session 6: Body Fluids and Electrolytes
Step 4: Factors Affecting Distribution of Body Water and Electrolytes (30
minutes)

Activity: Small Group Discussion (15 minutes)

DIVIDE students into small manageable groups

ALLOW the groups to discuss the factors and

WRITE their responses on manila cards and put on the wall

FACILITATE the proper classification of the factors

CONCLUDE by giving the factors as highlighted below

Age
 The water distribution in the body varies according to the body size, in that the smaller
the body, the larger is the water content as shown below:
o Infant 77% water
o Children 60-77%
o Adults 60%
 Infants and young children
o These are growing and therefore the fluid and electrolyte turn-over is much higher
o Additionally, they lose much fluid than adults. because:
o Kidneys are not mature to prevent loss of water
o Babies breath much faster rate than adults, losing more fluids in the process
 For these reasons, fluid loss in children is much critical than n adults
 Old age
o Elderly individuals are at risk of fluid and electrolyte imbalance as tissues are poorly
o Responsive to water conserving processes, increasing the risk for hydration.
o Additionally old age may be associated with heart diseases, kidney diseases.

Gender and Body Size


 The amount of fluids and electrolyte in an individual is affected by gender and body size.
 Women because they have proportionately more fat than men lose more water than men

Other Factors
 Diet
 Environment - extreme heat
 Stress
 Illness - burns, renal diseases

NMT 06120 Biochemistry


NTA Level 6, Semester 1 34
Session 6: Body Fluids and Electrolytes
Step 5: Clients with Fluid and Electrolyte Imbalance (30 minutes)

Activity: Small Group Discussion (20 minutes)

DIVIDE students into small manageable groups

PREPARE cards by writing on each one of the following on each card:


Electrolyte imbalance, over hydration, and dehydration.

PROVIDE one card to each group.

ALLOW 2-3 groups write down the common causes of dehydration, over hydration and
electrolyte imbalance for 5 minutes

ALLOW groups to present their responses in front of others for 1 minute each

SUMMARIZE the responses

 Imbalance of fluids and electrolytes is a serious complication which could result in body
dysfunction.
 The common dysfunctions include; dehydration, over hydration and electrolyte loss.

Dehydration
 Fluid is lost in the extracellular compartment first, after which fluid will be drawn from
the intracellular compartment in order to maintain equilibrium.

Fluid Volume Deficit


 Dehydration differs from fluid volume deficit in that; in dehydration, the loss in fluid is
not accompanied with the loss of electrolytes.
 In fluid volume deficit however, both electrolytes and fluids are lost at equal at equal
proportions.
 Because of excessive loss of water in dehydration is associated with excessive amounts of
sodium
 Causes
 Vomiting and diarrhea
 Decreased intake of water as in:
o Coma
o Difficulty in swallowing
o NGT
o Fever
 Bowel obstruction
 Burns

Fluid Volume Excess


 Can occur as a result of:
o Excessive retention of sodium and water
o Renal failure
o Excessive iv fluids

NMT 06120 Biochemistry


NTA Level 6, Semester 1 35
Session 6: Body Fluids and Electrolytes
Step 6: Key Points (05 minutes)

 Water is the single most abundant in humans


 Electrolytes and water are essential for various body functions
 The distribution of water and electrolytes is affected by: age,sex, environment, and illness
 Water and electrolyte imbalances can cause life threatening complications

Step 7: Evaluation (10 minutes)

 List the major functions of water and electrolytes


 What factors affect the distribution of water and electrolytes in the body?
 Mention causes of body fluid and electrolyte imbalances

ASK students if they have any comments or need clarification on any points.

References

 Harper P (2004). Practical Genetic Counseling. London. Arnold


 King, S. F. & Burgess, A. (2000). Nutrition for Developing Countries (2nd ed). USA:
Felicity Oxford University Press.
 Kumar, P. & Clark, M. (2006). Clinical Medicine (6th ed). USA: Elsevier Limited.
 Latham, M. C. (1997). Human Nutrition in the Developing World. David Lubin Memorial
Library.
 McLaren, D. S. (1992). A Color Atlas and Text of Diet-Related Disorders (2nd ed).
Aylesbury, England: BPCC Hazells Ltd.
 Tanzania Food and Nutrition Centre (2009). National Guidelines for Nutrition Care and
Support for People Living with HIV (2nd ed) Tanzania: TFNC
 The Human Genetic Society of Australia (HGSA) online. Available from:
httpwww.hgsa.com.au. (Accessed August, 2011).
 Wardlaw G.M. (2003). Contemporary Nutrition: Issues and Insights (4th ed). USA: Mc
Graw-Hill.
 Wardlaw, G.M. (2003). Contemporary Nutrition: Issues and Insights (5th ed). USA: Mc
Graw-Hill.

NMT 06120 Biochemistry


NTA Level 6, Semester 1 36
Session 6: Body Fluids and Electrolytes
Session 7: Concepts in Genetics in Promoting Health
and Preventing Ill-Health
Total Session Time: 60 Minutes

Prerequisites
 None

Learning Tasks
By the end of this session, students are expected to be able to:
 Define genetics, DNA, genes, mutations and chromosomes
 Classify types of hereditary diseases

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Computer and LCD
 Handout 6.1: Care of Clients with Genetic Diseases

SESSION OVERVIEW
Step Time Activity/ Method Content

1 05 Minutes Presentation Presentation of Session Title and Learning


Tasks
2 10 Minutes Presentation, Definition of Genetics, DNA, Genes, Mutation,
Brainstorm and Chromosomes
3 35 Minutes Presentation Types of Genetic Diseases
Group Discussion
4 05 Minutes Presentation Key points

5 05 Minutes Presentation Evaluation

SESSION CONTENT

Step 1: Presentation of Session Title and Learning Tasks (5 minutes)


READ or ASK students to read the learning tasks and clarify.

ASK students if they have any questions before proceeding.

NMT 06120 Biochemistry


NTA Level 6, Semester 1 37 Session 7: Concepts in Genetics in Promoting
Health and Preventing Ill-Health
Step 2: Introduction and Definition of Genetics, DNA, Gene, Mutation,
Chromosomes (10 minutes)

 In the development of diseases, both the environment and genetic factors play a role.
 Genetic diseases are diseases caused by abnormalities in an individual’s DNA
 Genetic diseases can be caused by any of the following:
o Gene mutation
o Gene deletion
o Abnormal extension of a gene
o Chromosomal abnormalities

Activity: Brainstorming (5 minutes)

ASK students to brainstorm on the definitions of: Genetics, DNA, gene, mutation, and
chromosome

ALLOW few students to provide responses and others provide unmentioned responses.

WRITE their responses on the black board or flip chart.

SUMMARIZE their responses using the information below.

Genetics
 Is defined as the study of inheritance of diseases in families, or simply, the study of
genes.
 Genetics is important in nursing practice because it will broaden your understanding on
care of newborns, children and adults suffering from inherited diseases, adults at risk of
or predisposed to development of cancer predisposed to genes i

DNA
 Deoxyribonucleic acid is a hereditary material in all organisms
 It is a ladder-like two strand helix formed by base pairs attached to a sugar backbone.
 The genetic information in DNA is stored coded made up of four bases: adenine (A,
guanine (G), cytosine (C) and thymine (T)
 The order and sequence of these bases determine the information required to the
organism.

NMT 06120 Biochemistry


NTA Level 6, Semester 1 38 Session 7: Concepts in Genetics in Promoting
Health and Preventing Ill-Health
Figure 7.1: Chromosome

Genes
 Are defined as the basic physical and functional unit of heredity.
 Genes are made up of DNA, and acts as instructional molecules to make proteins.
 Every individual has two copies of genes, each inherited from one parent

Mutation
 Refers to a permanent change in the DNA sequence within a gene or chromosome of an
organism.
 Mutations can be inherited from ones parents or acquired during an individual’s lifetime.

Chromosome
 Are thread-like structures of DNA and associated proteins in the nucleus of cells that
carries genes and functions in transmission of genetic information.
 In humans there are 46 chromosomes made up of 23 pairs. There are 44 chromosomes
and two sex chromosomes X and Y.
 Women chromosomes are identified as 46, XX whereas male chromosomes are 46, XY
 The father passes through his sperm 23 pairs of chromosomes, and the mother passes 23
pairs to her child through her egg.
Step 3: Classification of Types of Genetic diseases (35 minutes)

NMT 06120 Biochemistry


NTA Level 6, Semester 1 39 Session 7: Concepts in Genetics in Promoting
Health and Preventing Ill-Health
 For an individual to inherit a disease, depends on the type of chromosome affected ie:
whether the affected chromosome is autosomal or is a sex chromosome
 Also whether the trait is dominant or recessive

Activity: Small Group Discussion (15 minutes)

DIVIDE students into small manageable groups.

Ask the students to identify and discuss the types of genetic diseases and their
classification.

SUMMARIZE By using the information given below:

Table 1: Types of genetic diseases


Autosomal Sex-linked
Dominant Recessive Dominant Recessive
You need to get Two copies of A single abnormal gene Usually occurs in
one abnormal gene abnormal gene in on X chromosome can females, because they
from one parent to must be present for cause disease. have only one X
inherit the disease the disease to If father has an abnormal chromosome, a single
from one of the 22 develop. X gene, will pass the recessive gene on that
non sex People with one disease to all his chromosome will cause
chromosomes defective gene are daughters the disease
careers, can pass
the disease to their
children
Neurofibromatosis Sickle Cell Disease Extremely rare Hemophilia

Step 4: Key Points (05 minutes)

 Is defined as the study of inheritance of diseases in families, or simply, the study of


genes.
 Genetic diseases can be caused by any of the following:
o Gene mutation
o Gene deletion
o Abnormal extension of a gene
o Chromosomal abnormalities

Step 5: Evaluation (05 minutes)

 What is the meaning of the following terms: gene, chromosome, autosomal dominant
 List four common genetic diseases
 Mention type of clients would benefit from genetic counseling?
 What steps are involved in genetic counseling?

ASK students if they have any comments or need clarification on any points.

NMT 06120 Biochemistry


NTA Level 6, Semester 1 40 Session 7: Concepts in Genetics in Promoting
Health and Preventing Ill-Health
References

 Harper P (2004). Practical Genetic Counseling. London. Arnold


 King, S. F. & Burgess, A. (2000). Nutrition for Developing Countries (2nd ed). USA:
Felicity Oxford University Press.
 Kumar, P. & Clark, M. (2006). Clinical Medicine (6th ed). USA: Elsevier Limited.
 Latham, M. C. (1997). Human Nutrition in the Developing World. David Lubin Memorial
Library.
 McLaren, D. S. (1992). A Color Atlas and Text of Diet-Related Disorders (2nd ed).
Aylesbury, England: BPCC Hazells Ltd.
 Tanzania Food and Nutrition Centre (2009). National Guidelines for Nutrition Care and
Support for People Living with HIV (2nd ed) Tanzania: TFNC
 The Human Genetic Society of Australia (HGSA) online. Available from:
httpwww.hgsa.com.au. (Accessed August, 2011).
 Wardlaw G.M. (2003). Contemporary Nutrition: Issues and Insights (4th ed). USA: Mc
Graw-Hill.
 Wardlaw, G.M. (2003). Contemporary Nutrition: Issues and Insights (5th ed). USA: Mc
Graw-Hill.

NMT 06120 Biochemistry


NTA Level 6, Semester 1 41 Session 7: Concepts in Genetics in Promoting
Health and Preventing Ill-Health
NMT 06120 Biochemistry
NTA Level 6, Semester 1 42 Session 7: Concepts in Genetics in Promoting
Health and Preventing Ill-Health
Session 8: Concepts in Genetics in Promoting Health
and Preventing Ill-Health
Total Session Time: 120 Minutes

Prerequisites
 None

Learning Tasks
By the end of this session, students are expected to be able to:
 List types of common genetic diseases
 Describe types of inherited diseases
 Explain the care of common genetic diseases

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Computer and LCD
 Handout 8.1: Care of Clients with Genetic Diseases

SESSION OVERVIEW

Step Time Activity/ Method Content

1 05 Minutes Presentation Presentation and Session Title and Learning


Tasks
2 20 Minutes Presentation Common Genetic Diseases

3 20 Minutes Presentation, Multfactorial complex ( Non- Mendelian


Group Discussion Inheritance )
4 35 Minutes Presentation, Care to Patients with Genetic Diseases
Group Discussion
5 30 Minutes Presentation Counseling Clients with Genetic Diseases

6 05 Minutes Presentation Key Points

7 05 Minutes Presentation Evaluation

SESSION CONTENT

Step 1: Presentation of Session Title and Learning Tasks (5 minutes)


READ or ASK the students to read the learning tasks and clarify

ASK students if they have any questions before proceeding

NMT 06120 Biochemistry


NTA Level 6, Semester 1 43 Session 8: Concepts in Genetics in
Promoting Health and Preventing Ill-Health
Step 2: Common Genetic Diseases (20 minutes)
Single Gene Inheritance/Mendelian Inheritance
 Is the type of inheritance caused by changes or mutations that occur in a single gene.
 Single gene disorders occur in approximately one out of every 200 births
 Examples of common single gene disease include:

Sickle Cell Disease


 Is the commonest blood disorder caused by inherited abnormal haemoglobin.
 The abnormal haemoglobin causes distortion (sickling) of the red blood cells when
exposed to low oxygen tension.
 Sickle cell disease is an inherited as autosomal (gene not linked to sex chromosome)
 For disease to occur, a sickle cell gene has to be inherited from the mother and father so
that the child has two sickle cell genes.
 Inheritance of one gene from one parent leads to a sickle cell trait, a career state.
 The sickled red blood cells break easily resulting in anemia.
 Further, the sickled red cells can block blood vessels leading to severe pains and damage
to tissues.

Figure 9.1 Normal red blood cell and sickle cell

Source: Medicinenet.Inc

NMT 06120 Biochemistry


NTA Level 6, Semester 1 44 Session 8: Concepts in Genetics in Promoting
Health and Preventing Ill-Health
Cystic Fibrosis
 An inherited disease due to a defect in the gene which makes protein that controls
movement of water and salt
 Causes excessive mucous in lungs and digestive tract
 Individuals inherit the faulty genes from each parents
 There is accumulation of thick and sticky mucous in the lungs, blocking air passages
 Excessive loss of salts in sweat resulting in dehydration and loss of electrolytes
 Inherited as autosomal recessive

Hemophilia
 Is a X-linked genetically inherited recessive disease
 One or more of blood clotting factors is not produced
 Clients have excessive bleeding from even minor cuts the mucous and sweat glands
 The disease affects males, females are carriers

Phenylketonuria
 Is a body chemistry disorder
 Cannot breakdown amino acid phenylketonuria
 If untreated, leads to severe mental retardation
 Autosomal recessive disorder

Step 3: Multifactorial Complex (non-Mendelian Inheritance) (20 minutes)

 This is the type of inheritance the disease is caused by a combination of environmental


factors, and mutations in multiple genes.
 Examples:
o There are multiple genes which influence susceptibility to breast cancer in
chromosome 6, 11, 13, 15, 16, 17 and 22.
o Other diseases including: diabetes mellitus, heart diseases, high blood pressure
obesity

Chromosomal Inheritance
 These diseases are due to abnormality in the structure of chromosome including:
o Missing or extra chromosomal copies, deletion:
o Gross breaks and rejoining (Translocation)
o Examples:
 Downs’ syndrome, a common disorder that happen when an individual has three
copies of chromosome 21.

NMT 06120 Biochemistry


NTA Level 6, Semester 1 45 Session 8: Concepts in Genetics in Promoting
Health and Preventing Ill-Health
Step 4: Care to Patients with Genetic Diseases (35 minutes)

Activity: Small Group Discussion Care of Client with Genetic Disease (20 minutes)

DIVIDE students into small manageable groups.

PREPARE cards by writing one of the following genetic diseases: Sickle cell disease,
Phenylketonuria, and cystic fibrosis

DIVIDE the students into four groups of students and provide the genetic disease cards to
each group so each has one card.

ALLOW 2-3 groups write down the care plan for the patient with the given genetic disease
for 5 minutes

ALLOW groups to present their responses in front of others for 2 minute each

SUMMARIZE the responses using information below

Disease Defect Care


Sickle Cell Disease Abnormal haemoglobin  Genetic counseling
Anaemia, and painful crisis  Transfusion
 Supportive care
Phenylketonuria -Unable to metabolize amino acid  Prenatal screening, and
phenylalanine (Phe) counseling
-Mental retardation  Phenylalanine free diet 
-Skin and eye depigmentation  Supportive care
Cystic Fibrosis  Deficiency of clotting factors  Genetic counseling
 Accumulation of thick mucus  Avoid smoke
in lungs and GIT  Antibiotics, clear airway
 Supportive care
Haemophilia  Deficiency of clotting factors  Genetic counseling
 Fresh blood transfusion
 Supportive caret
Galactosemia  Cannot metabolize galactose  Genetic counseling
 Galactose converted to a toxic  Galactose free diet
product  Supportive care

Step 5: Counseling Clients and Relatives with Genetic Diseases (30


minutes)

 Genetic counseling is defined as a process by which patients and families at risk of a


disorder which maybe hereditary are advised on the consequences of the disease, the
potential of developing or transmitting it and ways in which it can be prevented

NMT 06120 Biochemistry


NTA Level 6, Semester 1 46 Session 8: Concepts in Genetics in Promoting
Health and Preventing Ill-Health
 Genetic counseling is important to the family or individual diagnosed with genetic disease
because it helps the family and client cope with issues associated with the diagnosis
including:
o Emotional
o Psychological
o Medical
o Social and
o Economic consequences
 The goals of genetic counseling sessions are to:
o Increase the client/family understanding of the genetic disease and discuss
management options and the risks/benefits of testing
o Identify the clients/family members psychosocial tools necessary to cope with the
potential outcome of the disease
o Reduce the clients/family anxiety
o Diagnosis, carriers pre symptomatic testing

Steps in Genetic Counseling


 Consultation
o During this step, collect family history
o Make or confirm the diagnosis, could be either by clinical features or laboratory.
o If there is a genetic history in the family, the following can be done:
o Estimate risks to other members or in future children or
o Reassure if it is not likely to recur in the family
o Discuss possible consequences, management, support and
o Referral, providing written documents
o Discuss reproductive options, including:
 Termination of pregnancy
 In case of exposure to possible teratogens (chemicals or 
 Drugs radiations which can cause birth defects) 
 Discuss what options are available

Follow-up
 Ongoing support to client and family,
 Be ready to answer further questions which may arise in future

Who Provides the Genetic Counseling?


 Is provided by a team of many disciplines including:
 Clinicians and experts including cancer doctors, neurologists Clinicians and experts
including cancer doctors, neurologists
 Nurses
 Social workers
 Other allied health workers

When to Seek Genetic Counseling?


 In case of conditions which run in families
 When the other child has serious problem in growth, health or development
 In case One family member has unusual features or serious health disease
 In marriages involving blood relatives
 Fetal abnormality detected during pregnancy

NMT 06120 Biochemistry


NTA Level 6, Semester 1 47 Session 8: Concepts in Genetics in Promoting
Health and Preventing Ill-Health
 Exposure to chemicals, drugs or agents which could cause birth defects.

Step 7: Key Points (10 minutes)

 Genetic counseling is important to the family or individual diagnosed with genetic disease
 Genetic diseases can be caused by any of the following:
o Gene mutation
o Gene deletion
o Abnormal extension of a gene
o Chromosomal abnormalities

Step 8: Evaluation (10 minutes)

 List four common genetic diseases


 Mention type of clients would benefit from genetic counseling?
 What steps are involved in genetic counseling?

ASK students if they have any comments or need clarification on any points

References

 Harper P (2004). Practical Genetic Counseling. London. Arnold


 King, S. F. & Burgess, A. (2000). Nutrition for Developing Countries (2nd ed). USA:
Felicity Oxford University Press.
 Kumar, P. & Clark, M. (2006). Clinical Medicine (6th ed). USA: Elsevier Limited.
 Latham, M. C. (1997). Human Nutrition in the Developing World. David Lubin Memorial
Library.
 McLaren, D. S. (1992). A Color Atlas and Text of Diet-Related Disorders (2nd ed).
Aylesbury, England: BPCC Hazells Ltd.
 Tanzania Food and Nutrition Centre (2009). National Guidelines for Nutrition Care and
Support for People Living with HIV (2nd ed) Tanzania: TFNC
 The Human Genetic Society of Australia (HGSA) online. Available from:
httpwww.hgsa.com.au. (Accessed August, 2011).
 Wardlaw G.M. (2003). Contemporary Nutrition: Issues and Insights (4th ed). USA: Mc
Graw-Hill.
 Wardlaw, G.M. (2003). Contemporary Nutrition: Issues and Insights (5th ed). USA: Mc
Graw-Hill.

NMT 06120 Biochemistry


NTA Level 6, Semester 1 48 Session 8: Concepts in Genetics in Promoting
Health and Preventing Ill-Health
Session 9: Metabolic Disease and Care of Patients with
Electrolyte Imbalance
Total Session Time: 120 Minutes

Prerequisites
 None

Leaning Tasks
By the end of this session, students are expected to be able to:
 Explain common Metabolic diseases
 Describe care of patients with Fluid and Electrolyte balance
 List steps in counseling clients with genetic diseases

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Handout 9.1: Counselling Clients with Grenetis Diseases

SESSION OVERVIEW
Step Time Activity/ Method Content

1 05 Minutes Presentation Presentation of Session Title and Learning


Tasks
2 30 Minutes Presentation Common Metabolic Disorders Related to
Biochemistry
3 60 Minutes Presentation, Care of Clients with Fluid and Electrolyte
Group Discussion Imbalance
4 15 Minutes Presentation Steps in Counseling the Clients with Genetic
Diseases
5 05 Minutes Presentation, Key Points
Group Discussion
6 05 Minutes Presentation Evaluation

SESSION CONTENT

Step 1: Presentation of Session Title and Learning Tasks (05 minutes)


READ or ASK the students to read the learning tasks and clarify

ASK students if they have any questions before proceeding

NMT 06120 Biochemistry


NTA Level 6, Semester 1 49 Session 9: Metabolic Disease and Care of
Patients with Electrolyte Imbalance
Step 2: Common Metabolic Disorders Related to Biochemistry (60 minutes)

 Metabolic disorders arise because of congenital defect in some of the enzymes involved
in metabolism.
 The enzyme defect could be total absence of an enzyme or partial
 If the enzyme is completely absent, such condition leads to death in utero or early death
soon after birth.
 Without treatment, children with partial deficiency may live, only to die later in
childhood.

Activity: Small Group Discussion Common Metabolic diseases(15 minutes)

DIVIDE students into small groups.


.
ALLOW the groups to discuss for five (5 minutes) on types of metabolic diseases, their
presentation and management

ALLOW students to present their responses

SUMMARIZE by the information given below

Table 9.1: Common Metabolic Diseases


Metabolic Disease Enzyme defect Metabolic defect Management

Von Gierke’s Glucose-6- Liver unable to provide free


Disease phosphate glucose, resulting in severe fasting
hypoglycaemia
Congenital Lactic Pyruvate Accumulation of lactic acid.
acidosis dehydrogenase
deficiency
Galactosemia UridyltransferaseExcess galactose is converted to Galactose-free
galacticol causing liver damage, diet
mental retardation and cataract.
Glucose-6-phosphate Glucose-6- Failure to neutralize peroxides and
dehydrogenase phosphate free radicals in red blood cells
Deficiency (G6PD) dehydrogenase resulting in rupture of cells leading
(G6PD) to hemolytic anaemia

Carnitine palmitoyl Carnitine Malnutrotion,vegetarianism, dialysis


Transferase deficiency

Ketoacidosis Uncontrolled Formation of ketone bodies exceeds Insulin therapy


type I diabetes utilization Replacement of
mellitus fluids and
electrolytes

NMT 06120 Biochemistry


NTA Level 6, Semester 1 50 Session 9: Metabolic Disease and Care of
Patients with Electrolyte Imbalance
Metabolic Disease Enzyme defect Metabolic defect Management

Familial LDL receptor Cells unable to internalize Limit cholesterol


hypercholesterolemia deficiency cholesterol. in diet
Excess cholesterol in blood Use cholesterol
Clogging of blood vessels lowering drugs

Liver diseases Alanine These are normal liver enzymes,


aminotransferase when found in blood indicate liver
Aspartat damage
aminotransferase
Hyperammonemia Carbamoyl Cannot form urea Limit protein in
phosphate Accumulation of ammonia diet
synthetase
Phenylketonuria Phenylalanine Phenylalanine cannot be converted Special diet
(PKU) hydroxylase to tyrosine without
Accumulation of phenylalanine phenylalanine
Mental retardation

Step 3: Care of Patients with Fluid and Electrolyte Imbalance (30 minutes)

 Careful attention is required in the care of patients with fluid and electrolyte imbalance
because if administered wrongly, deaths or serious ill health may arise due to fluid and
electrolyte imbalances.
 The care of a patient with fluid and electrolyte imbalance involves the following steps:

Assessment of Fluid and Electrolyte Status


 History
o Take proper history, in case of a baby, prenatal, natal and postnatal
 Laboratory Evaluation
 Depending on the history, and the suspected cause of fluid and electrolyte imbalance, the
following teats are important:
o Serum electrolyte
o Urea and nitrogen and creatinine
o Accurate total urine output
o Urine electrolyte and specific gravity
o Blood gas analysis if metabolic acidosis is suspected

Management of Fluid and Electrolyte Imbalance


 The primary goal in the management of fluid and electrolyte imbalance is to ensure
normal ECF volume, and ECF and, ICF, osmolariry and electrolyte concentration.
 This requires constant monitoring of:
o Intake and output
o Laboratory chemistry

NMT 06120 Biochemistry


NTA Level 6, Semester 1 51 Session 9: Metabolic Disease and Care of
Patients with Electrolyte Imbalance
Total Fluid Required
 The amount of fluid required for maintenance is (IWL + urine volume + stool water +
growth requirement in children
 The amount of water kidneys needs to excrete wastes is 60-80mL/kg/d.
 Stool requirement is usually 5-10mL/kg/d
 A growing infant require an extra 20-25mL/kg/d

Other factors
 Environmental temperature increases IWL
 Skin defects as in burns

Step 4: Steps in Counseling to Patients with Genetic Disease (15 minutes)

 Steps
1. Risk assessment and calculation of imperic risks
2. Apt and appropriate counseling will then be given
3. Explain nature and transmittance pattern of disorders
4. Provide occurrence rate and estimated risks for recurrence of the disorder in a future
offspring
 Metabolic errors arise due to congenital defect in some of the enzymes involved in
metabolism.
 If the enzyme is completely absent, such condition leads to early death in childhood.

Step 5: Key Points (5 minutes)

 Loss of fluids and electrolytes may lead to serious complications


 Care is required in handling clients with fluid and electrolyte imbalance
 Management of clients with metabolic diseases depend on the type of the disorder
 Genetic counseling to patients with genetic disease requires a teamwork involving nurses,
doctors and social workers

Step 6: Evaluation (5 minutes)

 List three major metabolic disorders


 Outline care of clients with metabolic diseases
 Explain steps involved in the care of client with fluid and electrolyte imbalance

ASK students if they have any comments or need clarification on any points.

References

 Harper P (2004). Practical Genetic Counseling. London. Arnold


 King, S. F. & Burgess, A. (2000). Nutrition for Developing Countries (2nd ed). USA:
Felicity Oxford University Press.
 Kumar, P. & Clark, M. (2006). Clinical Medicine (6th ed). USA: Elsevier Limited.
 Latham, M. C. (1997). Human Nutrition in the Developing World. David Lubin Memorial
Library.

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 McLaren, D. S. (1992). A Color Atlas and Text of Diet-Related Disorders (2nd ed).
Aylesbury, England: BPCC Hazells Ltd.
 Tanzania Food and Nutrition Centre (2009). National Guidelines for Nutrition Care and
Support for People Living with HIV (2nd ed) Tanzania: TFNC
 The Human Genetic Society of Australia (HGSA) online. Available from:
httpwww.hgsa.com.au. (Accessed August, 2011).
 Wardlaw G.M. (2003). Contemporary Nutrition: Issues and Insights (4th ed). USA: Mc
Graw-Hill.
 Wardlaw, G.M. (2003). Contemporary Nutrition: Issues and Insights (5th ed). USA: Mc
Graw-Hill.

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NTA Level 6, Semester 1 53 Session 9: Metabolic Disease and Care of
Patients with Electrolyte Imbalance
Handout 9.1: Counselling Clients with Grenetic Diseases

Counseling Clients with Genetic Disease

 Genetic counseling is a health care service aimed at helping individuals and families
understand the science of genetics and how it may relate to them.
 Counselors are health professionals with specialized education, training, and experience
in medical genetics and counseling.
 They work with people who may have an increased chance of having a child with an
inherited condition or with a birth difference or defect.
 They provide information that helps families make personal decisions about pregnancy,
child care and genetic testing.

Who should consider having genetic counseling?


 Pregnant women whose ultrasound examinations or blood testing indicate that their
pregnancy may be at increased risk for certain complications or birth defects
 Anyone who has unanswered questions about diseases, chromosome abnormalities or a
birth defect in their family or partner’s family such as:
o Autism
o Down syndrome or other chromosome problem
o Mental disability (mental retardation)
o Birth difference or defect (examples: cleft lip or palate, spina bifida, anencephaly,
heart defect)
o Hearing or vision loss in infancy or childhood
o Blood disorders (examples: hemophilia, thalassemia, sickle cell anemia)
o Muscular dystrophy or neuromuscular disease (examples: Duchenne muscular
dystrophy, myotonic dystrophy)
 any inherited conditions (examples: cystic fibrosis, Huntington’s disease )
 Anyone who carries a chromosome rearrangement
 Couples, in which both members are found to carry the same genetic condition that
occurs more frequently in specific ethnic groups or have had a “soft marker” or
abnormality detected on a prenatal ultrasound
 Couples who already have a child with a mental handicap, an inherited disorder or a birth
defect
 Couples whose infant has a genetic disease diagnosed by routine newborn screening
 Women who have had babies who died in infancy
 People concerned that their jobs, lifestyles or medical history may pose a risk to outcome
of pregnancy (common causes of concern include exposure to radiation, medications,
illegal drugs, chemicals or infections)
 Couples who are first cousins or other close blood relatives

Genetic Counseling Process


 A counselor will record your medical background and family medical history.
 He or she may then offer to arrange additional appointments for further investigation (e.g.
amniocentesis).

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NTA Level 6, Semester 1 54 Session 9: Metabolic Disease and Care of
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 Genetic counselors also help you understand medical information about any risks and
explain the role of genetics for these conditions. Often, they can determine the risk of
occurrence or recurrence of a condition and the availability of tests for it.

How can a genetic counselor help a client


 If there are decisions to be made about a pregnancy, the care of a child, having more
children, or about the ability of the family to cope with ongoing problems, parents can
make more informed choices with the facts in hand.
 The counselor’s role is to provide an unbiased, complete and accurate view of the
situation, the nature of the birth defect being investigated, and what — in practical terms
— its occurrence would mean for all involved.
 If a birth defect is diagnosed, genetic counselors can provide emotional support during
what can be a very difficult time, and help connect a family with support groups for
specific genetic conditions.
 The concept of genetic defects can be frightening and confusing.
 Counselors are trained to help translate and simplify the information, and act as an
emotional resource.

The Counselor/Client Relationship


 A genetic counselor’s primary concern is the interests of his or her client. Counseling is
based on values of care and respect for the client’s autonomy, individuality, welfare, and
freedom.
 Therefore, genetic counselors are integral members of the "genetic team" and strive to be
patient advocates by:
 Equally serving all who seek services
 Respecting clients’ beliefs, cultural traditions, inclinations, circumstances, and feelings
 Enabling their clients to make informed independent decisions, free of coercion, by
providing or illuminating the necessary facts and clarifying the alternatives and
anticipated consequences
 Referring clients to other competent professionals when they are unable to support clients
 Maintaining confidentiality of any information about clients, unless previously released
by the client
 Avoiding exploitation of their clients for personal advantage, profit, or interest

NMT 06120 Biochemistry


NTA Level 6, Semester 1 55 Session 9: Metabolic Disease and Care of
Patients with Electrolyte Imbalance
NMT 06120 Biochemistry
NTA Level 6, Semester 1 56 Session 9: Metabolic Disease and Care of
Patients with Electrolyte Imbalance