Citric Acid Cycle & Anaplerosis | USMLE Step 1
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A 32-year-old man develops vomiting, agitation and a generalized seizure after accidentally ingesting a pesticide formulation. Ionized calcium is 0.94 mmol/L (laboratory reference 1.15–1.33). Analysis of the formulation identifies sodium fluoroacetate. Its toxicity requires conversion of fluoroacetyl-CoA to a fluorinated six-carbon cycle intermediate.