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Normally, LDL circulates in the blood and binds to its receptor on hepatocyte membranes and is then taken up into the liver and metabolized. In FH patients, LDL is taken up by the hepatocytes less efficiently, leading to elevated LDL levels in the blood. What would the microscopic examination of the lesions on this patient’s arms show? Cholesterol deposits in the skin, called xanthomas, form when there is a persistently elevated LDL level. They are composed largely of lipid-laden macrophages. Statin drugs are frequently used to treat this condition.

C A S E 00 Biochemistry Chapter 2 CASE 2 A 36-year-old chemist with a 15-year history of bipolar disorder is rushed to the emergency department by his wife, who found him lying unconscious in the living room of their home. The patient’s wife reports that he is prescribed lithium but does not regularly take it. The man’s skin is bright red, and he is breathing rapidly. Upon presentation, his breath smells like bitter almonds. What is the most likely diagnosis? This man has ingested cyanide (the “bitter almond” breath is pathognomonic).

What are the exceptions to confidentiality? There are a number of exceptions to confidentiality besides the age parameters that protect minors and the elderly. These exceptions rely on the physician’s judgment. If the potential harm to self or others is great or serious, then confidentiality may be violated to preserve the principle of beneficence. It is the responsibility of the physician to take steps to prevent harm if there are no alternative means to protect those at risk. What is the Tarasoff decision?

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