This study examined the use of carbohydrates by men and women during lift/carry exercise. Effects of menstrual cycle variation were examined in women. Twenty‐five subjects (15 M, 10 F) were studied; age 25 ± 2y M, 26 ± 3y F, weight 85 ± 3 kg* M, 63 ± 3 kg F, and height 181 ± 2 cm* M, 161 ± 2 cm F (* P < 0.0001). During exercise subjects squatted to floor level and lifted a 30 kg box, carried it 3 m, and placed it on a shelf 132 cm high 3X/min over a 3‐hour period (540 lifts) or until they could not continue. Males were studied in a single session, females were studied on separate occasions (during the luteal (L) and follicular (F) menstrual phases). The protocol was identical for both sexes and on both occasions in the female group. Glycogen utilization was tracked with natural abundance C‐13 NMR of quadriceps femoris and biceps brachialis muscles, and in the liver at rest and throughout the exercise period. Males completed more of the 180 min protocol than females [166 ± 9 min M, 112 ± 16 min* F (L), 88 ± 16 min** F (F) (*P = 0.0036, **P < 0.0001)]. Quadriceps glycogen depletion was similar between sexes and within females in L/F phases [4.7 ± 0.8 mmol/L‐h M, 4.5 ± 2.4 mmol/L‐h F (L), 10.3 ± 3.5 mmol/L‐h F (F)]. Biceps glycogen depletion was greater in females [2.7 ± 0.9 mmol/L‐h M, 10.3 ± 1.3 mmol/L‐h* F (L), 16.8 ± 4.8 mmol/L‐h** F (F) (* P = 0.0004, ** P = 0.0122)]. Resting glycogen levels were higher in females during the follicular phase (P = 0.0077). Liver glycogen depletion increased during exercise, but was not significant. We conclude that with non‐normalized lift/carry exercise: (1) Based on their smaller size, women are less capable of completing and work their upper body harder than men. (2) Women and men work their lower body at similar levels. (3) Women store more quadriceps carbohydrate during the follicular phase. (4) The liver is not significantly challenged by this protocol.

Unilateral adrenal infarction is a rare cause of acute abdomen in pregnancy (AAP). Its presentation is non-specific and requires a high index of suspicion with a low threshold to obtain radiographic imaging for diagnosis. Evaluating AAP is challenging as diagnostic radiographic imaging is often limited in relation to radiation exposure to the developing fetus. We describe a case of a 24-year-old pregnant female who presented with severe acute abdominal pain. The patient’s pain was refractory to intravenous analgesics and ultrasonography was inconclusive. Computed tomography (CT) scan was not obtained due to the risk of radiation exposure to the developing fetus. Due to the persistence of pain and suspicions for other serious etiologies, magnetic resonance imaging (MRI) was completed and the patient was diagnosed with acute unilateral adrenal infarction. In this case report, unilateral adrenal infarction was likely secondary to elevated plasma factor VIII levels. Even with the physiological elevation of factor VIII levels during pregnancy, levels greater than 150 IU/dL confer greater than five-fold increased risk of venous thrombosis. Once hemorrhage is excluded, patients should be started on therapeutic anticoagulation to prevent progression of adrenal infarct or infarction of the contralateral adrenal gland. Prompt recognition and treatment of acute adrenal infarction during pregnancy are of paramount importance to prevent adverse outcomes for both the mother and fetus.

Topiramate has a wide array of pharmacologic effects, including proximal renal tubular acidosis (RTA). Clinicians must be wary of the possibility for development of somnolence due to compensatory hyperventilation and cardiac dysrhythmias.

We present a case of a 45-year-old man admitted to the hospital with new-onset ascites and bilateral subconjunctival haemorrhages. He was found to have elevated liver enzymes in a hepatocellular pattern and direct hyperbilirubinemia. A diagnostic paracentesis was consistent with portal hypertension (PH). Extensive workup for acute and chronic liver disease was unremarkable. In the absence of clinical evidence of cirrhosis to explain PH, a liver biopsy with hepatic venous pressure gradient was pursued, which revealed proteinaceous material and apple-green birefringence under polarised light consistent with amyloid deposits. Bone marrow biopsy revealed plasma cell neoplasm with proteinaceous deposits consistent with concomitant multiple myeloma with AL amyloidosis. He developed rapidly progressive liver failure and passed shortly after presentation despite treatment with chemotherapy. This case illustrates how primary hepatic amyloidosis can present with a physiology that mimics cirrhosis and can easily be missed.