Skip to main content

Emergency Treatments

  • Chapter
Inborn Metabolic Diseases

Abstract

As soon as the diagnosis of a metabolic disorder is suspected, a plan for its emergency management should be made. As stated in ► Chapter 1, both the presentation and the management depend mainly on the pathophysiology involved. This chapter focuses on the main clinical presentations in neonates and children with those inborn errors of metabolism for which emergency treatment may be life saving and outlines the first steps of such treatment up to when the exact diagnosis is known. The subsequent management of patients is addressed in the specific chapters.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 159.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Bodamer OA, Hoffmann GF, Visser GH et al. (1997) Assessment of energy expenditure in metabolic disorders (review). Eur J Pediatr 156 [Suppl 1]:S24–28

    Google Scholar 

  2. Feillet F, Bodamer OA, Dixon MA, Sequeira S, Leonard JV (2000) Resting energy expenditure in disorders of propionate metabolism. J Pediatr 136:659–663

    Article  PubMed  CAS  Google Scholar 

  3. Nyhan WL, Rice-Kelts M, Klein J, Barshop BA (1998) Treatment of the acute crisis in maple syrup urine disease. Arch Pediatr Adolesc Med 152:593–598

    PubMed  CAS  Google Scholar 

  4. Wendel U, Langenbeck U, Lombeck I, Bremer HJ (1982) Maple syrup urine disease – therapeutic use of insulin in catabolic states. Eur J Pediatr 139:172–175

    Article  PubMed  CAS  Google Scholar 

  5. Picca S, Bartuli A, Dionisi-Vici C (2008) Medical management and dialysis therapy for the infant with an inborn error of metabolism. Semin Nephrol 28:477–480

    Article  PubMed  CAS  Google Scholar 

  6. Picca S, Dionisi-Vici C, Abeni D et al. (2001) Extracorporeal dialysis in neonatal hyperammonaemia: modalities and prognostic indicators. Pediatr Nephrol 16:862–867

    Article  PubMed  CAS  Google Scholar 

  7. Ogier de Baulny H (2002) Management and emergency treatments of neonates with a suspicion of an inborn error of metabolism. Semin Neonatol 7:17–26

    Article  PubMed  Google Scholar 

  8. Prietsch V, Lindner M, Zschocke J, Nyhan WL, Hoffmann GF (2002) Emergency management of inherited metabolic diseases. J Inherit Metab Dis 25:531–546

    Article  PubMed  CAS  Google Scholar 

  9. Ogier de Baulny H, Benoist JF, Rigal O et al. (2005) Methylmalonic and propionic acidaemias: management and outcome. J Inherit Metab Dis 28:415–423

    Article  PubMed  Google Scholar 

  10. Brusilow SW, Maestri NE (1996) Urea cycle disorders: diagnosis, physiopathology, and therapy. Adv Pediatr 43:127–170

    PubMed  CAS  Google Scholar 

  11. Enns GM, Berry SA, Berry GT et al. (2007) Survival after treatment with phenylacetate and benzoate for urea-cycle disorders. N Engl J Med 356: 2282–2292

    Article  PubMed  CAS  Google Scholar 

  12. Walter JH, Wraith JE, Cleary MA (1995) Absence of acidosis in the initial presentation of propionic acidaemia. Arch Dis Child Fetal Neonatal Ed 72(3):F197–199

    Article  PubMed  CAS  Google Scholar 

  13. Dave P, Curless R, Steinman L (1984) Cerebellar hemorrhage complicating methylmalonic and propionic acidemia. Arch Neurol 41:1293–1296

    PubMed  CAS  Google Scholar 

  14. Surtees R, Leonard JV (1989) Acute metabolic encephalopathy: a review of causes, mechanisms and treatment. J Inherit Metab Dis 12 [Suppl 1]:42–54

    Article  PubMed  Google Scholar 

  15. Orban T, Mpofu C, Blackensee D (1994) Severe CNS bleeding followed by a good clinical outcome in the acute neonatal form of isovaleric aciduria. J Inherit Metab Dis 17:755–756

    Article  PubMed  CAS  Google Scholar 

  16. Berry GT, Heidenreich R, Kaplan P et al. (1991) Branched-chain amino acid-free parenteral nutrition in the treatment of acute metabolic decompensation in patients with maple syrup urine disease. N Engl J Med 324:175–179

    Article  PubMed  CAS  Google Scholar 

  17. Khaler SG, Millington DS, Cederbaum SD et al. (1989) Parenteral nutrition in propionic and methylmalonic acidemia. J Pediatr 115:235–241

    Article  Google Scholar 

  18. Parini R, Sereni LP, Bagozzi DC et al. (1993) Nasogastric drip feeding as the only treatment of neonatal maple syrup urine disease. Pediatrics 92:280–283

    PubMed  CAS  Google Scholar 

  19. Thompson GN, Francis DE, Halliday D (1991) Acute illness in maple syrup urine disease: dynamics of protein metabolism and implications for management. J Pediatr 119:35–41

    Article  PubMed  CAS  Google Scholar 

  20. Ruch T, Kerr D (1982) Decreased essential aminoacid requirements without catabolism in phenylketonuria and maple syrup urine disease. Am J Clin Nutr 35:217–228

    PubMed  CAS  Google Scholar 

  21. Biggemann B, Zass R, Wendel U (1993) Postoperative metabolic decompensation in maple syrup urine disease is completely prevented by insulin. J Inherit Metab Dis 16:912–913

    Article  PubMed  CAS  Google Scholar 

  22. Leonard JV, Umpleby AM, Naughten EM, Boroujerdy MA, Sonksen PH (1983) Leucine turnover in maple syrup urine disease. J Inherit Metab Dis 6 [Suppl 2]:117–118

    Article  Google Scholar 

  23. Feillet F, Leonard JV (1998) Alternative pathway therapy for urea cycle disorders (review). J Inherit Metab Dis 21 [Suppl 1]:101–111

    Article  PubMed  CAS  Google Scholar 

  24. Coman D, Yaplito-Lee J, Bonch A (2008) New indications and controversies in arginine therapy. Clin Nutr 27:489–496

    Article  PubMed  CAS  Google Scholar 

  25. Griffith AD, Cyr DM, Egan SG, Tremblay GC (1989) Inhibition of pyruvate carboxylase by sequestration of coenzyme A with sodium benzoate. Arch Biochem Biophys 15/269;201–207

    Article  Google Scholar 

  26. Kalbag SS, Palekar AG (1988) Sodium benzoate inhibits fatty acid oxidation in rat liver: effect on ammonia levels. Biochem Med Metab Biol 40:133–142

    Article  PubMed  CAS  Google Scholar 

  27. Petrowski S, Nyhan WL, Reznik V et al. (1987) Pharmacologic amino acid acylation in the acute hyperammonemia of propionic acidemia. J Neurogenet 4:87–96

    PubMed  CAS  Google Scholar 

  28. Filipowicz HR, Ernst SL, Ashurst CL, Pasquali M, Longo N (2006) Metabolic changes associated with hyperammonemia in patients with propionic acidemia. Mol Genet Metab 88:123–130

    Article  PubMed  CAS  Google Scholar 

  29. Gebhardt B, Vlaho S, Fischer D et al. (2003) N-Carbamoylglutamate enhances ammonia detoxification in a patient with decompensated methylmalonic aciduria. Mol Genet Metab 79:303–304

    Article  PubMed  CAS  Google Scholar 

  30. Chalmers RA, Roe CR, Stacey TE, Hoppel CL (1984) Urinary excretion of l-carnitine and acylcarnitines by patients with disorders of organic acid metabolism: evidence for secondary insufficiency of l-carnitine. Pediatr Res 18:1325–1328

    Article  PubMed  CAS  Google Scholar 

  31. Roe CR, Millington DS, Maltby DA, Bohan TP, Hoppel CL (1984) l-Carnitine enhances excretion of propionyl coenzyme A as propionylcarnitine in propionic acidemia. J Clin Invest 73:1785–1788

    Article  PubMed  CAS  Google Scholar 

  32. Matern D, Seydewitz HH, Lehnert W et al. (1996) Primary treatment of propionic acidemia complicated by acute thiamine deficiency. J Pediatr 129:758–760

    Article  PubMed  CAS  Google Scholar 

  33. Mayatepek E, Schulze A (1999) Metabolic decompensation and lactic acidosis in propionic acidaemia complicated by thiamine deficiency. J Inherit Metab Dis 22:189–190

    Article  PubMed  CAS  Google Scholar 

  34. Roe CR, Millington DS, Maltby DA, Kahler SG, Bohan TP (1984) L-Carnitine therapy in isovaleric acidemia. J Clin Invest 74:2290–2295

    Article  PubMed  CAS  Google Scholar 

  35. Schaefer F, Straube E, Oh J, Mehls O, Mayatepek E (1999) Dialysis in neonates with inborn errors of metabolism. Nephrol Dial Transplant 14:910–918

    Article  PubMed  CAS  Google Scholar 

  36. Jouvet P, Poggi F, Rabier D et al. (1997) Continuous venovenous haemodiafiltration in the acute phase of neonatal maple syrup urine disease. J Inherit Metab Dis 20:463–472

    Article  PubMed  CAS  Google Scholar 

  37. Rutledge SL, Havens PL, Haymond MW et al. (1990) Neonatal hemodialysis: effective therapy for the encephalopathy of inborn errors of metabolism. J Pediatr 116:125–128

    Article  PubMed  CAS  Google Scholar 

  38. Ring E, Zobel G, Stoeckler S (1990) Clearance of toxic metabolites during therapy for inborn errors of metabolism. J Pediatr 117:349–350

    PubMed  CAS  Google Scholar 

  39. Falk MC, Knight JF, Roy LP et al. (1994) Continuous venovenous haemofiltration in the acute treatment of inborn errors of metabolism. Pediatr Nephrol 8:330–333

    Article  PubMed  CAS  Google Scholar 

  40. Thompson GN, Butt WW, Shann FA et al. (1991) Continuous venovenous hemofiltration in the management of acute decompensation in inborn errors of metabolism. J Pediatr 118:879–884

    Article  PubMed  CAS  Google Scholar 

  41. Summar M, Pietsch J, Deshpande J, Schulman G (1996) Effective hemodialysis and hemofiltration driven by an extracorporeal membrane oxygenation pump in infants with hyperammonemia. J Pediatr 128:379–382

    Article  PubMed  CAS  Google Scholar 

  42. Saudubray JM, Ogier H, Charpentier C et al. (1984) Neonatal management of organic acidurias clinical update. J Inherit Metab Dis 7:2–9

    Article  PubMed  Google Scholar 

  43. Donn SM, Swartz RD, Thoene JG (1979) Comparison of exchange transfusion, peritoneal dialysis, and hemodialysis for the treatment of hyperammonemia in an anuric newborn infant. J Pediatr 95:67–70

    Article  PubMed  CAS  Google Scholar 

  44. Wendel U, Langenbeck U, Lombeck I, Bremer HJ (1982) Exchange transfusion in acute episodes of maple syrup urine disease: studies on branched-chain amino and keto acids. Eur J Pediatr 138:293–296

    Article  PubMed  CAS  Google Scholar 

  45. Goertner L, Leupold D, Pohlandt F, Bartmann P (1989) Peritoneal dialysis in the treatment of metabolic crises caused by inherited disorders of organic and amino acid metabolism. Acta Pediatr Scand 78:706–711

    Article  Google Scholar 

  46. Pela I, Seracini D, Donati MA, Lavoratti G, Pasquini E, Materassi M (2008) Peritoneal dialysis in neonates with inborn errors of metabolism: is it really out of date? Pediatr Nephrol 23:163–168

    Article  PubMed  Google Scholar 

  47. Alexander SR (1990) Continuous arteriovenous hemofiltration. In: Levin DL, Morris FC (eds) Essentials of pediatric intensive care. Quality Medical, St Louis, Mo, pp 1022–1048

    Google Scholar 

  48. Gouyon JB, Desgres J, Mousson C (1994) Removal of branchedchain amino acids by peritoneal dialysis, continuous arteriovenous hemofiltration, and continuous arteriovenous hemodialysis in rabbits: implications for maple syrup urine disease treatment. Pediatr Res 35:357–361

    Article  PubMed  CAS  Google Scholar 

  49. Casadevall I, Ogier H, Germain JF et al. (1992) Hémofiltration artérioveineuse continuée: prise en charge d’un cas de leucinose néonatale. Arch Fr Pediatr 49:803–805

    PubMed  CAS  Google Scholar 

  50. Sperl W, Geiger R, Maurer H et al. (1992) Continuous arteriovenous haemofiltration in a neonate with hyperammonaemic coma due to citrullinemia. J Inherit Metab Dis 15:158–159

    Article  PubMed  CAS  Google Scholar 

  51. Wiegand C, Thompson T, Bock GH, Mathis RK (1980) The management of life-threatening hyperammonemia: a comparison of several therapeutic modalities. J Pediatr 96:142–144

    Article  PubMed  CAS  Google Scholar 

  52. Barkaoui E, Debray D, Habès D, Ogier H, Bernard O (1999) Favorable outcome of treatment with NTBC of acute liver insufficiency disclosing hereditary tyrosinemia type I. Arch Pediatr 6:540–544

    Article  PubMed  CAS  Google Scholar 

  53. Nobili V, Jenkner A, Francalanci P, Castellano A et al. (2010) Tyrosinemia type 1: metastatic hepatoblastoma with a favorable outcome. Pediatrics 126: e235-e238

    Article  PubMed  Google Scholar 

  54. Stacpoole PW, Barnes CL, Hurbanis MD, Cannon SL, Kerr DS (1997) Treatment of congenital lactic acidosis with dichloroacetate. Curr Top Arch Dis Child 77:535–541

    Article  CAS  Google Scholar 

  55. Mochel F, de Lonlay P, Touati G et al. (2005) Pyruvate carboxylase deficiency: clinical and biochemical response to anaplerotic diet therapy. Mol Genet Metab 84: 305–312

    Article  PubMed  CAS  Google Scholar 

  56. Schmitt B, Baumgartner M, Mills PB et al. (2010) Seizures and paroxysmal events: symptoms pointing to the diagnosis of pyridoxine-dependent epilepsy and pyridoxine phosphate oxidase deficiency. Dev Med Child Neurol 52: e133-e142

    Article  PubMed  Google Scholar 

  57. Gallagher RC, Hove v JL, Scharer G et al. (2009) Folinic acid-responsive seizures are identical to pyridoxine-dependent epilepsy. Ann Neurol 65: 550–556

    Article  PubMed  CAS  Google Scholar 

  58. MacDonald A, Dixon M, White F (2008) Disorders of amino acid metabolism, organic acidemias and urea cylce defects. In: Shaw V, Lawson M (eds) Clinical paediatric dietetics, 3rd edn. Blackwell, Oxford, UK, chap 17

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Dionisi-Vici, C., Ogier de Baulny, H. (2012). Emergency Treatments. In: Saudubray, JM., van den Berghe, G., Walter, J.H. (eds) Inborn Metabolic Diseases. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-15720-2_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-15720-2_5

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-15719-6

  • Online ISBN: 978-3-642-15720-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics