1) Patient History
sex: female
birth year: 1931
weight: height: BMI: 17 lean
Recent History
post-herpetic pain treated with analgesic pills (3/4 a day)
Ferritin: 28 ug/L
Bilirubin
- Total 1,83
- Direct 0,42
- Indirect 1,41
Past History
Previous HSV infection
Gilbert's Syndrome
Familial History
2) Molecular bases of symptoms
Pain
the higher the stimulus, the higher the spikes frequency...
![](http://flipper.diff.org/static/files/61/osc%20calcium%20vasopressin.gif)
but we get the same results when the intracellula ATP is low....
![](http://flipper.diff.org/static/files/58/asimmetria%20ioni%20700.gif)
![](http://www.rehab.research.va.gov/jour/02/39/2/Waxmanf06.gif)
which local conditions can affect ATP synthesis?
![](http://flipper.diff.org/static/files/58/Krebs%20551.gif)
- Less oxygen transport
- Less CoQ
- Less Cyt C
- low estrogens--> low heme synthesis
- iron deficiency
- hypothyroidism
- Less glucose
3) Therapeutic approach aimed to correct metabolic alterations
Iron supplementation
Coenzyme Q
Complex B Vitamins
After 4 weeks
Ferritin: 48 ug/L
Night and most of the day free of pain but...
around 11 a.m. pain requiring an analgesic pill
4 Rule:Oscillating
Serum cortisol at this time is at its nadir: breakfast carbohydrates are gone. Poor gluconeogenesis and sodium retention.
![](http://flipper.diff.org/static/files/58/Na%20H%20antiport%20502.gif)
Pain by glucose nerve starvation
but also by lack of Na+ (Hyponatremia)
prevention of pain with saltine crackers at 10.30
![](http://upload.wikimedia.org/wikipedia/commons/1/12/PremiumSaltines.jpg)
After 8 weeks
Ferritin: 76 ug/L
No pain anymore at 11 even without additional crackers