1. A Case Study

2. Story The Comona Farm near the town of Helgen was well known for its superior strawberry fruits and products. Helgen is a mining town, mainly focusing on the extraction of a variety of metals and minerals. For the last 20 years, both the mine and the Comona Farm were famous for their high productivity and profitability.

3. Story After a long day of labor on the strawberry farm, a few friends from the work crew gathered at a well for a well- deserved drink of water. Roger, Eddy, and Brianna each took turns drinking from the well while Vlad drank from his canteen. After some good laughter about the last Superbowl play that ended in failure, the four friends split and went home.

4. Story Later that week during a shift, Roger, Eddy, and Brianna were working much more slowly than usual. They were complaining of abdominal pains and nausea. All three were suffering symptoms such as emesis, delirium, and black water urine. It wasn’t a pleasant day for either one of them.

5. Story The next day, Vlad found himself alone for his shift that he usually worked along with his three friends. He called all three of them but no one answered. After a few more days of their absence and failure to answer their phones, Vlad worriedly called the police to search for his friends.

6. Story The authorities eventually found all of Vlad’s friends. Unfortunately, they were all deceased in their homes. Soon after, more farmers started missing their shifts for work.

7. Symptoms Exhibited By Most Victims: Delirium Nausea Headache Black Water Urine Shortness of breath/rapid breathing Emesis (Vomiting)  Most deaths were very rapid, occurring within a few hours of the symptoms.

8. Autopsy Report Immediate cause of death was hypoxia (suffocation or lack of oxygen). Tissue sections from the heart, lung, kidney, and liver all show massive cell death. Staining with specific dyes showed major mitochondrial damage within the affected tissues. Oxygen levels in the patients’ blood were approximately 115mm Hg (normal range is 75- 100mm Hg).

9. ATP Analysis  A more detailed analysis of the cells from the farmers hearts showed that ATP levels were very low in the mitochondria.  In addition, Acetyl- Coenzyme A levels were less than normal. In fact, Acetyl- CoA was entirely absent from the victims.

10. Part 1: (Sub-cellular Analysis) Using a new chromatographic technology, various levels of sub-cellular components of the heart cells were obtained. Key highlights of the report were listed below. MetaboliteAutopsy FindingNormal Levels Glucose99 μmol100 μmol Pyruvate115 μmol25 μmol FADH 2 0 μmol15 μmol NADH49 μmol50 μmol