Metabolic Problems in Pediatrics Metabolic Problems in Pediatrics H.E
Total Page:16
File Type:pdf, Size:1020Kb
Load more
Recommended publications
-
Hyperammonemia in Review: Pathophysiology, Diagnosis, and Treatment
Pediatr Nephrol DOI 10.1007/s00467-011-1838-5 EDUCATIONAL REVIEW Hyperammonemia in review: pathophysiology, diagnosis, and treatment Ari Auron & Patrick D. Brophy Received: 23 September 2010 /Revised: 9 January 2011 /Accepted: 12 January 2011 # IPNA 2011 Abstract Ammonia is an important source of nitrogen and is the breakdown and catabolism of dietary and bodily proteins, required for amino acid synthesis. It is also necessary for respectively. In healthy individuals, amino acids that are not normal acid-base balance. When present in high concentra- needed for protein synthesis are metabolized in various tions, ammonia is toxic. Endogenous ammonia intoxication chemical pathways, with the rest of the nitrogen waste being can occur when there is impaired capacity of the body to converted to urea. Ammonia is important for normal animal excrete nitrogenous waste, as seen with congenital enzymatic acid-base balance. During exercise, ammonia is produced in deficiencies. A variety of environmental causes and medica- skeletal muscle from deamination of adenosine monophos- tions may also lead to ammonia toxicity. Hyperammonemia phate and amino acid catabolism. In the brain, the latter refers to a clinical condition associated with elevated processes plus the activity of glutamate dehydrogenase ammonia levels manifested by a variety of symptoms and mediate ammonia production. After formation of ammonium signs, including significant central nervous system (CNS) from glutamine, α-ketoglutarate, a byproduct, may be abnormalities. Appropriate and timely management requires a degraded to produce two molecules of bicarbonate, which solid understanding of the fundamental pathophysiology, are then available to buffer acids produced by dietary sources. differential diagnosis, and treatment approaches available. -
Effect of Propionic Acid on Fatty Acid Oxidation and U Reagenesis
Pediat. Res. 10: 683- 686 (1976) Fatty degeneration propionic acid hyperammonemia propionic acidemia liver ureagenesls Effect of Propionic Acid on Fatty Acid Oxidation and U reagenesis ALLEN M. GLASGOW(23) AND H. PET ER C HASE UniversilY of Colorado Medical Celller, B. F. SlOlillsky LaboralOries , Denver, Colorado, USA Extract phosphate-buffered salin e, harvested with a brief treatment wi th tryps in- EDTA, washed twice with ph os ph ate-buffered saline, and Propionic acid significantly inhibited "CO z production from then suspended in ph os ph ate-buffe red saline (145 m M N a, 4.15 [I-"ejpalmitate at a concentration of 10 11 M in control fibroblasts m M K, 140 m M c/, 9.36 m M PO" pH 7.4) . I n mos t cases the cells and 100 11M in methyl malonic fibroblasts. This inhibition was we re incubated in 3 ml phosph ate-bu ffered sa lin e cont aining 0.5 similar to that produced by 4-pentenoic acid. Methylmalonic acid I1Ci ll-I4Cj palm it ate (19), final concentration approximately 3 11M also inhibited ' 'C0 2 production from [V 'ejpalmitate, but only at a added in 10 II I hexane. Increasing the amount of hexane to 100 II I concentration of I mM in control cells and 5 mM in methyl malonic did not impair palmit ate ox id ation. In two experiments (Fig. 3) the cells. fibroblasts were in cub ated in 3 ml calcium-free Krebs-Ringer Propionic acid (5 mM) also inhibited ureagenesis in rat liver phosphate buffer (2) co nt ain in g 5 g/ 100 ml essent iall y fatty ac id slices when ammonia was the substrate but not with aspartate and free bovine se rum albumin (20), I mM pa lm itate, and the same citrulline as substrates. -
Hepatic Glycogen Storage Diseases: Pathogenesis, Clinical Symptoms and Therapeutic Management
State of the art paper Hepatology Hepatic glycogen storage diseases: pathogenesis, clinical symptoms and therapeutic management Edyta Szymańska1, Dominika A. Jóźwiak-Dzięcielewska2, Joanna Gronek2, Marta Niewczas3, Wojciech Czarny4, Dariusz Rokicki1, Piotr Gronek2 1Department of Gastroenterology, Hepatology, Feeding Disorders and Pediatrics, Corresponding author: The Children’s Memorial Health Institute, Warsaw, Poland Edyta Szymańska MD, PhD 2Laboratory of Genetics, Department of Gymnastics and Dance, University School Department of Physical Education, Poznan, Poland of Gastroenterology, 3Department of Sport, Faculty of Physical Education, University of Rzeszow, Rzeszow, Hepatology, Feeding Poland Disorders and 4Department of Human Sciences, Faculty of Physical Education, University of Rzeszow, Pediatrics Rzeszow, Poland The Children’s Memorial Health Institute Submitted: 13 October 2017; Accepted: 8 December 2017; Al. Dzieci Polskich 20 Online publication: 18 February 2019 Warsaw, Poland Phone: +48 22 815 74 94 Arch Med Sci 2021; 17 (2): 304–313 E-mail: edyta.szymanska@ DOI: https://doi.org/10.5114/aoms.2019.83063 ipczd.pl Copyright © 2019 Termedia & Banach Abstract Glycogen storage diseases (GSDs) are genetically determined metabolic diseases that cause disorders of glycogen metabolism in the body. Due to the enzymatic defect at some stage of glycogenolysis/glycogenesis, excess glycogen or its pathologic forms are stored in the body tissues. The first symptoms of the disease usually appear during the first months of life and are thus the domain of pediatricians. Due to the fairly wide access of the authors to unpublished materials and research, as well as direct contact with the GSD patients, the article addresses the problem of actual diag- nostic procedures for patients with the suspected diseases. -
Propionic Acidemia Information for Health Professionals
Propionic Acidemia Information for Health Professionals Propionic acidemia is an organic acid disorder in which individuals are lacking or have reduced activity of the enzyme propionyl-CoA carboxylase, leading to propionic acidemia. Clinical Symptoms Symptoms generally begin in the first few days following birth. Metabolic crisis can occur, particularly after fasting, periods of illness/infection, high protein intake, or during periods of stress on the body. Symptoms of a metabolic crisis include lethargy, behavior changes, feeding problems, hypotonia, and vomiting. If untreated, metabolic crises can lead to tachypnea, brain swelling, cardiomyopathy, seizures, coma, basal ganglia stroke, and death. Many babies die within the first year of life. Lab findings during a metabolic crisis commonly include urine ketones, hyperammonemia, metabolic acidosis, low platelets, low white blood cells, and high blood ammonia and glycine levels. Long term effects may occur despite treatment and include developmental delay, brain damage, dystonia, failure to thrive, short stature, spasticity, pancreatitis, osteoporosis, and skin lesions. Incidence Propionic acidemia occurs in greater than 1 in 75,000 live births and is more common in Saudi Arabians and the Inuit population of Greenland. Genetics of propionic acidemia Mutations in the PCCA and PCCB genes cause propionic acidemia. Mutations prevent the production of or reduce the activity of propionyl-CoA carboxylase, which converts propionyl-CoA to methylmalonyl-CoA. This causes the body to be unable to correctly process isoleucine, valine, methionine, and threonine, resulting in an accumulation of glycine and propionic acid, which causes the symptoms seen in this condition. How do people inherit propionic acidemia? Propionic acidemia is inherited in an autosomal recessive manner. -
What Is Ketotic Hypoglycemia?
KETOTICHYPOGLYCEMIA.ORGv Ketotic Hypoglycemia International Who we are, what we do and why Ketotic Hypoglycemia INTERNATIONAL What is ketotic hypoglycemia? “Ketotic hypoglycemia may be unexplained, or idiopathic (IKH). This is a challenge and should urge for more research” For the patients In a normal person, fuel for the brain and the general cell metabolism primarily comes from the burning of sugar deposits (glycogen). When the glycogen stores are depleted, the body will switch to burn fat deposits. The fat burn lead to two fuels for the brain, both glucose (sugar) and ketone bodies. However, ketones in the blood will lead to nausea and eventually vomiting. This will lead to a vicious circle, where you cannot eat or drink sugar-rich items, which again leads to further fat burn and production of ketone bodies. In a KH-patient, the glycogen stores are somehow insufficient. This leads to For the doctors decreased fasting tolerance with earlier Ketotic hypoglycemia can be seen in children Emergency treatment constitutes of oral onset of fat burn and hence ketone bodies. In because of growth hormone deficiency, cortisol or i.v. glucose, eventually i.m. glucagon, to most patients, the hypoglycemia is relatively deficiency, metabolic diseases with intact fatty raise the plasma glucose, which will prevent mild, and the ketone bodies helps to provide acid consumption, including glycogen storage further lipolysis. However, the ketones can fuel to the brain, which prevents loss of diseases (glycogenosis; GSD) type 0, III, VI, and take hours to be eliminated. In more severely consciousness and convulsions. However, in IX, or disturbances in transport or metabolism affected patients, the ketone production relatively few patients, the condition is more of ketone bodies. -
Arginine-Provider-Fact-Sheet.Pdf
Arginine (Urea Cycle Disorder) Screening Fact Sheet for Health Care Providers Newborn Screening Program of the Oklahoma State Department of Health What is the differential diagnosis? Argininemia (arginase deficiency, hyperargininemia) What are the characteristics of argininemia? Disorders of arginine metabolism are included in a larger group of disorders, known as urea cycle disorders. Argininemia is an autosomal recessive inborn error of metabolism caused by a defect in the final step in the urea cycle. Most infants are born to parents who are both unknowingly asymptomatic carriers and have NO known history of a urea cycle disorder in their family. The incidence of all urea cycle disorders is estimated to be about 1:8,000 live births. The true incidence of argininemia is not known, but has been estimated between 1:350,000 and 1:1,000,000. Argininemia is usually asymptomatic in the neonatal period, although it can present with mild to moderate hyperammonemia. Untreated, argininemia usually progresses to severe spasticity, loss of ambulation, severe cognitive and intellectual disabilities and seizures Lifelong treatment includes a special diet, and special care during times of illness or stress. What is the screening methodology for argininemia? 1. An amino acid profile by Tandem Mass Spectrometry (MS/MS) is performed on each filter paper. 2. Arginine is the primary analyte. What is an in-range (normal) screen result for arginine? Arginine less than 100 mol/L is NOT consistent with argininemia. See Table 1. TABLE 1. In-range Arginine Newborn Screening Results What is an out-of-range (abnormal) screen for arginine? Arginine > 100 mol/L requires further testing. -
Novel Insights Into the Pathophysiology of Kidney Disease in Methylmalonic Aciduria
Zurich Open Repository and Archive University of Zurich Main Library Strickhofstrasse 39 CH-8057 Zurich www.zora.uzh.ch Year: 2017 Novel Insights into the Pathophysiology of Kidney Disease in Methylmalonic Aciduria Schumann, Anke Posted at the Zurich Open Repository and Archive, University of Zurich ZORA URL: https://doi.org/10.5167/uzh-148531 Dissertation Published Version Originally published at: Schumann, Anke. Novel Insights into the Pathophysiology of Kidney Disease in Methylmalonic Aciduria. 2017, University of Zurich, Faculty of Medicine. Novel Insights into the Pathophysiology of Kidney Disease in Methylmalonic Aciduria Dissertation zur Erlangung der naturwissenschaftlichen Doktorwürde (Dr. sc. nat.) vorgelegt der Mathematisch-naturwissenschaftlichen Fakultät der Universität Zürich von Anke Schumann aus Deutschland Promotionskommission Prof. Dr. Olivier Devuyst (Vorsitz und Leitung der Dissertation) Prof. Dr. Matthias R. Baumgartner Prof. Dr. Stefan Kölker Zürich, 2017 DECLARATION I hereby declare that the presented work and results are the product of my own work. Contributions of others or sources used for explanations are acknowledged and cited as such. This work was carried out in Zurich under the supervision of Prof. Dr. O. Devuyst and Prof. Dr. M.R. Baumgartner from August 2012 to August 2016. Peer-reviewed publications presented in this work: Haarmann A, Mayr M, Kölker S, Baumgartner ER, Schnierda J, Hopfer H, Devuyst O, Baumgartner MR. Renal involvement in a patient with cobalamin A type (cblA) methylmalonic aciduria: a 42-year follow-up. Mol Genet Metab. 2013 Dec;110(4):472-6. doi: 10.1016/j.ymgme.2013.08.021. Epub 2013 Sep 17. Schumann A, Luciani A, Berquez M, Tokonami N, Debaix H, Forny P, Kölker S, Diomedi Camassei F, CB, MK, Faresse N, Hall A, Ziegler U, Baumgartner M and Devuyst O. -
Disease Reference Book
The Counsyl Foresight™ Carrier Screen 180 Kimball Way | South San Francisco, CA 94080 www.counsyl.com | [email protected] | (888) COUNSYL The Counsyl Foresight Carrier Screen - Disease Reference Book 11-beta-hydroxylase-deficient Congenital Adrenal Hyperplasia .................................................................................................................................................................................... 8 21-hydroxylase-deficient Congenital Adrenal Hyperplasia ...........................................................................................................................................................................................10 6-pyruvoyl-tetrahydropterin Synthase Deficiency ..........................................................................................................................................................................................................12 ABCC8-related Hyperinsulinism........................................................................................................................................................................................................................................ 14 Adenosine Deaminase Deficiency .................................................................................................................................................................................................................................... 16 Alpha Thalassemia............................................................................................................................................................................................................................................................. -
Recurrent Severe Hypoglycemia Due to Isolated Growth Hormone
C O R R E S P O N D E N C E Recurrent Severe Hypoglycemia hyperinsulinism, ketotic hypoglycemia and hormonal deficiencies such as cortisol, GH and thyroxine [1]. GH due to Isolated Growth Hormone deficiency may occasionally manifest as recurrent Deficiency hypoglycemia as seen in our patient. The mechanisms of hypoglycemia in GH deficiency are increased insulin sensitivity and hypoglycemia unawareness [2]. Additionally, GH deficiency impairs carbohydrate meta- A 6-year-old boy presented to us with repeated episodes bolism resulting in deceased basal insulin level, impaired of seizures since early infancy. He was born small for insulin secretion and carbohydrate intolerance with gestational age to non-consanguineous parents at term. reactive hypoglycemia [1,2]. Although hypoglycemia is During neonatal period, he suffered multiple episodes of described in GH deficiency, severe symptomatic hypoglycemia requiring intravenous dextrose but no hypoglycemia is extremely rare and usually occurs in etiological investigations were done. Three of the four association with another causative factor such as hypoglycemic events beyond neonatal age were glycogen storage disorder [3,4]. Children with even associated with seizures. There were no precipitating complete GH deficiency do not usually manifest factors for hypoglycemia such as prolonged fasting, an hypoglycemia [5]. Our patient unusually developed intercurrent illness or intake of medications. There was recurrent episodes of severe symptomatic hypoglycemia no family history of similar illness, metabolic disorders or due to an isolated GH deficiency. an unexplained death. DEVI DAYAL AND JAIVINDER Y ADAV* On examination, he was short (106 cm, -2.02 z-score) Department of Pediatrics, and underweight (13.8 kg, -3.15 z-score) and had normal PGIMER, Chandigarh, India. -
Standards of Care
Dedicated to a Cure. Committed to Our Community. Infantile Nephropathic Cystinosis STANDARDS OF CARE A Reference for People with Infantile Nephropathic Cystinosis, their Families, and Medical Team Galina Nesterova, MD and William A. Gahl, MD, PhD, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland June 2012 Preface The Cystinosis Standards of Care were written to help individuals with infantile nephropathic Cystinosis, their families, and their medical team. The information presented here is intended to add to conversations with physicians and other health care providers. No document can replace individual interactions and advice with respect to treatment. One of our primary goals is to give affected individuals and their families greater confidence in the future. With early diagnosis and appropriate treatment, there is more hope today for families with Cystinosis than ever before. Research has led to better methods of diagnosis and treat- ment. Knowledge is increasing rapidly by virtue of the open sharing of information throughout the world among families, health professionals and the research community. We acknowledge the important contributions to the Standards of Care of Dr. Galina Nesterova and Dr. William Gahl of the National Institutes of Health and the members of the Cystinosis Research Network’s Medical and Scientific Review Boards. Cystinosis Research Network 302 Whytegate Court, Lake Forest, IL 60045 USA Phone: 847-735-0471 Toll Free: 866-276-3669 Fax: 847-235-2773 www.cystinosis.org E-mail: [email protected] The Cystinosis Research Network is an all-volunteer, non-profit organization dedicated to supporting and advocating research, providing family assistance and educating the public and medical communities about Cystinosis. -
The Pharmabiotic for Phenylketonuria: Development of a Novel Therapeutic
University of South Carolina Scholar Commons Senior Theses Honors College Spring 2019 The hP armabiotic for Phenylketonuria: Development of a Novel Therapeutic Chloé Elizabeth LeBegue University of South Carolina, [email protected] Follow this and additional works at: https://scholarcommons.sc.edu/senior_theses Part of the Alternative and Complementary Medicine Commons, Amino Acids, Peptides, and Proteins Commons, Biochemical Phenomena, Metabolism, and Nutrition Commons, Biotechnology Commons, Congenital, Hereditary, and Neonatal Diseases and Abnormalities Commons, Digestive, Oral, and Skin Physiology Commons, Digestive System Diseases Commons, Enzymes and Coenzymes Commons, Genetic Phenomena Commons, Medical Biotechnology Commons, Medical Genetics Commons, Medical Nutrition Commons, Medical Pharmacology Commons, Nutritional and Metabolic Diseases Commons, Other Pharmacy and Pharmaceutical Sciences Commons, Pharmaceutical Preparations Commons, Pharmaceutics and Drug Design Commons, and the Preventive Medicine Commons Recommended Citation LeBegue, Chloé Elizabeth, "The hP armabiotic for Phenylketonuria: Development of a Novel Therapeutic" (2019). Senior Theses. 267. https://scholarcommons.sc.edu/senior_theses/267 This Thesis is brought to you by the Honors College at Scholar Commons. It has been accepted for inclusion in Senior Theses by an authorized administrator of Scholar Commons. For more information, please contact [email protected]. THE PHARMABIOTIC FOR PHENYLKETONURIA: DEVELOPMENT OF A NOVEL THERAPEUTIC By Chloé Elizabeth -
Fatal Propionic Acidemia: a Challenging Diagnosis
Issue: Ir Med J; Vol 112; No. 7; P980 Fatal Propionic Acidemia: A Challenging Diagnosis A. Fulmali, N. Goggin 1. Department of Paediatrics, NDDH, Barnstaple, UK 2. Department of Paediatrics, UHW, Waterford, Ireland Dear Sir, We present a two days old neonate with severe form of propionic acidemia with lethal outcome. Propionic acidemia is an AR disorder, presents in the early neonatal period with progressive encephalopathy and death can occur quickly. A term neonate admitted to NICU on day 2 with poor feeding, lethargy and dehydration. Parents are non- consanguineous and there was no significant family history. Prenatal care had been excellent. Delivery had been uneventful. No resuscitation required with good APGAR scores. Baby had poor suck, lethargy, hypotonia and had lost about 13% of the birth weight. Initial investigations showed hypoglycemia (2.3mmol/L), uremia (8.3mmol/L), hypernatremia (149 mmol/L), severe metabolic acidosis (pH 7.24, HCO3 9.5, BE -18.9) with high anion gap (41) and ketonuria (4+). Hematologic parameters, inflammatory markers and CSF examination were unremarkable. Baby received initial fluid resuscitation and commenced on IV antibiotics. Generalised seizures became eminent at 70 hours of age. Loading doses of phenobarbitone and phenytoin were given. Hepatomegaly of 4cm was spotted on day 4 of life. Very soon baby became encephalopathic requiring invasive ventilation. At this stage clinical features were concerning for metabolic disorder and hence was transferred to tertiary care centre where further investigations showed high ammonia level (1178 μg/dl) and urinary organic acids were suggestive of propionic acidemia. Specific treatment for hyperammonemia and propionic acidemia was started.