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Hepatic glycogen stores are depleted within 24 hours. During prolonged starvation, glucose is produced by gluconeogenesis from lactate, glycerol, and amino acids.

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Urinary hCG is the most economical and highly significant laboratory test used to establish early pregnancy. Human chorionic gonadotropin (hCG) is produced by the developing placenta shortly after implantation. Urinary hCG tests are inexpensive, yield rapid results, and are highly sensitive and specific for confirming early pregnancy.

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BH4 is the essential cofactor for phenylalanine hydroxylase. BH4 deficiency causes atypical phenylketonuria with neurological manifestations.

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Reduced methionine decreases SAM production, impairing myelin methylation and causing subacute combined degeneration.

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The classic triad of biliary obstruction consists of conjugated hyperbilirubinemia, elevated ALP, and vitamin K-responsive coagulopathy.

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Vitamin B6-dependent CBS deficiency causes homocystinuria with lens dislocation and thrombosis.

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Defective tryptophan absorption reduces endogenous niacin synthesis.

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Bile salts are required for absorption of fat-soluble vitamins. Lack of bile causes vitamin K malabsorption.