A family took their newborn to the doctor. They were worried something was wrong because the baby seemed to be in constant pain. After medical tests revealed the baby had large amounts of lactic acid accumulating in his muscle cells, doctors diagnosed the child with a rare disease in which mitochondria are missing from skeletal muscle cells. How might the lack of mitochondria explain the large amounts of lactic acid in the baby's muscle cells

Glycolysis is the first step in the metabolism of glucose. By the process of glycolysis, glucose is converted to pyruvate with the generation of ATP and NADH. The pyruvate is then converted to acetyl CoA by the pyruvate dehydrogenase complex which then enters the TCA cycle. The NADH FADH2 generated by Glycolysis and TCA cycle donate their electrons to the electron transport chain which in turn helps in the generation of ATP. Both the TCA cycle and the Electron transport chain take place within the mitochondria. In the absence of mitochondria, NAD+ and FAD are regenerated by fermentation.

In the process of converting 3-carbon pyruvate to 3-carbon lactic acid (C3H6O3), lactic acid fermentation also regenerates NAD+, which enables glycolysis to continue producing ATP in the absence of mitochondria. This leads to the accumulation of lactic acid in muscle cells.

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