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Emergency Treatments

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Book cover Inborn Metabolic Diseases

Abstract

The emergency treatment of children suspected of having an inborn error of metabolism implies three simultaneous actions: collecting all samples necessary for the diagnosis, deciding on adequate treatment, and organizing clinical and biochemical supervision. As already stated in the first chapter (Saudubray et al.), management depends on the physiopathology involved. This chapter focuses on the emergency treatment of those disorders which lead to an acute intoxication secondary to accumulation of toxic compounds proximal to the metabolic block. Mainly, they comprise branched-chain organic acidurias (BCOA), urea cycle defects (UCD), and some β-oxidation defects. Age of onset (neonatal versus late-onset) and intercurrent decompensations are other aspects which influence management.

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References

  1. Berry GT, Heidenreich R, Kaplan P, Levine F, 16. Mazur A, Palmieri MJ, Yudkoff M, Segal S (1991) Branched-chain amino acid-free parenteral nutrition in the treatment of acute metabolic decompen- 17. sation in patients with maple syrup urine disease. N Engl J Med 324: 175–179

    Article  PubMed  CAS  Google Scholar 

  2. Parini R, Sereni LP, Bagozzi DC, Rabier D, Narcy C, Hubert P, Saudubray JM (1993) Nasogastric drip feeding as the only treatment of neonatal maple 18. syrup urine disease. Pediatrics 92: 280–283

    PubMed  CAS  Google Scholar 

  3. Khaler SG, Millington DS, Cederbaum SD, Vargas J, Bond LD, Maltby DA, Gale DS, Roe CR (1989) Parenteral nutrition in propionic and methylmalonic acidemia. J Pediatr 115: 235–241

    Article  Google Scholar 

  4. 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 

  5. 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 

  6. Saudubray JM, Ogier H, Charpentier C, Depondt E, Coudé FX et al (1984) Neonatal management of organic acidurias — clinical update. J Inherited Metab Dis 7: 2–9

    Article  PubMed  Google Scholar 

  7. 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 

  8. 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: 24. 706–711

    Article  Google Scholar 

  9. Brusilow SW, Batshaw ML, Waber L (1982) Neonatal hyperammonemic coma. Adv Pediatrics 29: 69–103

    CAS  Google Scholar 

  10. Herrin JT, McCredie DA (1969) Peritoneal dialysis in the reduction of blood ammonia levels in a case of hyperammonaemia. Arch Dis Childh 44: 149–151

    Article  PubMed  CAS  Google Scholar 

  11. Wiegang 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  Google Scholar 

  12. Harris RJ (1971) Treatment in maple syrup urine disease. Lancet 2: 813–814

    Article  PubMed  CAS  Google Scholar 

  13. Wendel U, Becker K, Przyrembel H, Bulla M, Manegold C, Mench-Hoinowski A, Lagenbeck U (1980) Peritoneal dialysis in maple syrup urine disease: studies on branched-chain amino and keto acids. Eur J Pediatr 134: 57–63

    Article  PubMed  CAS  Google Scholar 

  14. Alexander SR (1990) Continuous arteriovenous hemofiltration. In: Levin DL, Morris FC (eds.) Essential of pediatric intensive care. St Louis Missouri: Quality Medical Publishing Inc, pp 1022–1048

    Google Scholar 

  15. Gouyon JB, Desgres J, Mousson C (1994) Removal of branched-chain 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 

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

    PubMed  CAS  Google Scholar 

  17. Casadevall I, Ogier H, Germain JF, Daoud P, Hartmann JF, Mercier JC, Beaufils F (1992) Hemofiltration arterioveineuse continue: prise en charge d’un cas de leucinose néonatale. Arch Fr Pediatr 49: 803–805

    PubMed  CAS  Google Scholar 

  18. Thompson GN, Butt WW, Shann FA, Kirby DM, Henning RD, Howells DW, Osborne A (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 

  19. Falk MC, Knight JF, Roy LP, Wilcken B, Schell DN, O’Connell AJ, Gillis J (1994) Continuous venovenous haemofiltration in the acute treatment of inborn errors of metabolism. Pediatr Nephrol 8: 330–333

    Article  PubMed  CAS  Google Scholar 

  20. Sperl W, Geiger R, Maurer H, Murr C, Schmoigl C, Steichen-Gersdorf E, Sailer M (1992) Continuous arteriovenous haemofiltration in a neonate with hyperammonaemic coma due to citrulinemia. J Inherited Metab Dis 15: 158–159

    Article  PubMed  CAS  Google Scholar 

  21. Roth B, Younossi-Hartenstein A, Skopnik H, Leonard JV (1987) Hemodialysis for metabolic decompensation in propionic acidaemia. J Inherited Metab Dis 10: 147–151

    Article  PubMed  CAS  Google Scholar 

  22. Rutledge SL, Havens PL, Haymond MW, McLean RH, Kan JS, Brusilow SW (1990) Neonatal hemodialysis: effective therapy for the encephalopathy of inborn errors of metabolism. J Pediatr 116: 125–128

    Article  PubMed  CAS  Google Scholar 

  23. Maestri NE, Hauser ER, Bartholomew D, Brusilow SW (1991) Prospective treatment of urea cycle disorders. J Pediatr 119: 923–928

    Article  PubMed  CAS  Google Scholar 

  24. Biggemann B, Zass R, Wendel U (1993) Postopera- tive metabolic decompensation in maple syrup urine disease is completely prevented by insulin. J Inherited Metab Dis 16: 912–913

    Article  PubMed  CAS  Google Scholar 

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

    Article  Google Scholar 

  26. Surtees R, Leonard JV (1989) Acute metabolic encephalopathy: a review of causes, mechanisms and treatment. J Inherited Metab Dis 12 [Suppl 11: 42–54

    Article  Google Scholar 

  27. Riviello JJ, Rezvani I, DiGeorge AM, Foley CM (1991) Cerebral edema causing death in children with maple syrup urine disease. J Pediatr 119: 42–45

    Article  PubMed  Google Scholar 

  28. Dixon MA, Leonard JV (1992) Intercurrent illness in inborn errors of intermediary metabolism. Arch Dis Child 67: 1387–1391

    Article  PubMed  CAS  Google Scholar 

  29. Thompson GN, Francis DEM, 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 

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© 1995 Springer-Verlag Berlin Heidelberg

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de Baulny, H.O., Saudubray, JM. (1995). Emergency Treatments. In: Fernandes, J., Saudubray, JM., Van den Berghe, G., Tada, K., Buist, N.R.M. (eds) Inborn Metabolic Diseases. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-03147-6_3

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  • DOI: https://doi.org/10.1007/978-3-662-03147-6_3

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-03149-0

  • Online ISBN: 978-3-662-03147-6

  • eBook Packages: Springer Book Archive

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