Chapter

Organic Acidurias

pp 2-9

Hudson Memorial Lecture Neonatal Management of Organic Acidurias. Clinical Update

  • J. M. SaudubrayAffiliated withClinique et Unité de Recherche de Génétique Médicale Inserm U 12, Département de Pédiatrie, Hôpital Necker Enfants Malades
  • , H. OgierAffiliated withClinique et Unité de Recherche de Génétique Médicale Inserm U 12, Département de Pédiatrie, Hôpital Necker Enfants Malades
  • , C. CharpentierAffiliated withLaboratoire de Biochimie CHU
  • , E. DepondtAffiliated withClinique et Unité de Recherche de Génétique Médicale Inserm U 12, Département de Pédiatrie, Hôpital Necker Enfants Malades
  • , F. X. CoudéAffiliated withClinique et Unité de Recherche de Génétique Médicale Inserm U 12, Département de Pédiatrie, Hôpital Necker Enfants Malades
  • , A. MunnichAffiliated withClinique et Unité de Recherche de Génétique Médicale Inserm U 12, Département de Pédiatrie, Hôpital Necker Enfants Malades
  • , G. MitchellAffiliated withClinique et Unité de Recherche de Génétique Médicale Inserm U 12, Département de Pédiatrie, Hôpital Necker Enfants Malades
  • , F. ReyAffiliated withClinique et Unité de Recherche de Génétique Médicale Inserm U 12, Département de Pédiatrie, Hôpital Necker Enfants Malades
  • , J. ReyAffiliated withClinique et Unité de Recherche de Génétique Médicale Inserm U 12, Département de Pédiatrie, Hôpital Necker Enfants Malades
    • , J. FrézalAffiliated withClinique et Unité de Recherche de Génétique Médicale Inserm U 12, Département de Pédiatrie, Hôpital Necker Enfants Malades

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Abstract

Therapeutic guidelines have been obtained from a restrospective review of 41 patients affected with organic acidaemias, 16 patients with neonatal maple syrup urine disease (MSUD), 11 methylmalonic acidaemia, (MMA) seven propionic acidaemias (PA) and seven isovaleric acidaemias (IVA), and by comparing this personal series with similar reported cases. The emergency treatment of these organic acidurias in the neonate has to main goals: toxin removal and anabolism. Anabolism is always promoted by early diet therapy. The best method of toxin removal depends on the nature of the defect; peritoneal dialysis with exchange transfusions or multiple or prolonged exchange transfusions in MSUD and in PA., diuresis and exchange transfusions in MMA and glycine supplementation in IVA. Vitamin supplementation (thiamine 20 mg, biotin 10 mg, B12 2 mg and riboflavin 100 mg) should be tried in all cases although the neonatal forms of these defects are very rarely vitamin responsive. Additional treatments such as carnitine or insulin may prove to be useful.