A newborn was diagnosed as propionic acidemia

Öz

3000 gr term female infant while healthy at birth, after 24 hours the loss of tonus began to appear had referred to us breastfeeding difficulties, vomiting at third day. On her physical examination she was hypotonic, decreased turgor, dry mouth, decreased response to painful stimuli and tachypneic. Neonatal reflexes were decreased. In family history, there was second degree consanguinity between her parents. In her father's second degree relatives sudden infant death history was seen. During follow-up, she developed hypoglisemia, persistent myoclonic convulsions, metabolic acidosis, renalfailure. On tandem mass spectrometric analysis (Tandem MS), C3-propionyl carnitin level was increased. Urine organic acid analysis revealed increased 3-OH propionic acid, fumaric acid, andpropionylglycine levels. She was diagnosed as propionic acidemia and a protein restricted diet and biotin supplementations were started. In our country, where the prevalence of consanguineous marriages is very high, inborn errors of metabolism should be strongly considered in all of those full term neonates and children who develop hypotonia, failure to thrive and convulsion after an uneventful labor, as well as in those developing signs and symptoms of neonatal sepsis without any risk factors baby.

Anahtar Kelimeler

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Propiyonik asidemi tanısı konulan bir yenidoğan

Öz

Doğumda sağlıklı iken 24 saatten sonra tonus kaybı belirmeye başlayan ,üçüncü gün emmede azalma ve kusma şikayeti ile kliniğimize başvuran 3000 gr zamanında doğan kız bebek fizik muayenesinde letarjik, hipotonik, turgoru azalmış, ağız mukozası kuru, ağrılı uyarana yanıtı azalmış ve takipneik olarak gözlendi. Yenidoğan refleksleri azalmıştı. Aile hikayesinde anne-baba arasında ikinci derece akraba evliliği ve babanın ikinci derece akrabalarında ani bebek ölümü hikayesi olan hastanın takibinde hipoglisemi, dirençli miyoklonik nöbetler, metabolik asidoz ve böbrek yetmezliği gelişti. Tandem mass spektrometrik (Tandem MS) analizi sonucu yüksek plazma C3-Propiyonil karnitin düzeyi saptandı. Ayrıca idrar organik asit incelemesinde 3-OHpropiyonik asit, fumarik asit vepropiyonil glisin seviyelerinde artış gözlendi. Bu bulgular ışığında hastaya propiyonik asidemi tanısı kondu. Proteinden fakir diet, biotin tedavisi başlandı. Akraba evliliğinin yaygın olduğu ülkemizde sağlıklı doğmuş ancak hipotonisi, emme güçlüğü ve konvülsiyonu olan yenidoğan veya herhangi bir risk faktörü yokken neonatal sepsis tablosu gelişen bebeklerde doğumsal metabolizma hastalıkları daima akılda tutulmalıdır.

Anahtar Kelimeler

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Kaynakça

1. 1. Wolf B, Hsia YE, Sweetman L, Gravel R, Haris DJ, Nyhan WL. Propionic acidemia: a clinical update. J Pediatr 1981; 99; 835-846
2. 2. Özalp İ, Coşkun T, Tokol S, Demircin G, Mönch E. Inherited metabolic disorders in Turkey. J Inherit Metab Dis 1990; 13; 732-738
3. 3. Fenton WA, Gravel WA, Rosenblatt DS. Disorders of propionate and methylmalonate in metabolism. In: Scriver CR Beudet AL, Sly WS, Vale D, eds. New York: McGraw-Hill, 2001; 2165-2193
4. 4. Tokatlı A, Coşkun T, Özalp İ. A retrospective evaluation of 78 cases with organic acidemia. Turk J Med Sc 1993; 18; 47-53
5. 5. Kalkanoğlu S, Coşkun T, Tokatlı A, Topçu M, Özalp İ. The profiles of organic acidemia patients in Turkey: a 23 year experience. BMJG 1998; 1; 175-177.0o-2-deoxyglucose (18FDG) PET scan of the brain in propionic acidemia: clinical and MRI correlations. Brain Dev 1999; 21; 312-317
6. 9. Brismar J, Ozand PT. CT and MR of the brain in the diagnosis of organic acidemias. Experiences from 107 patients. Brain DAEV 1994; 16; 104-124
7. 10. Lehnert W, Sperl W, Suormala T, Baumgartner R Propionic acidaemia: clinical, biochemical and therapeutic aspects. Experience in 30 patients. Eur J Pediatr 1994; 153; 68-80
8. 11. Sweetman L, Williams JC. Branched chain organic acidurias. In: Scriver CR Beaudet AL, Sly WS, Vale D,eds. The Metabolic and Molecular Basis of Inherited Disease. 8th ed. New York: McGraw-Hill; 2001; 2125-2163

9. 12. Ogier de Baulny H, Saudubray JM. Branched-chain organic acidurias. In: Fernandes J, Saudubray JM, van den Berghe G, eds. Inborn Metabolic Diseases. 3rd ed. Berlin, Heidelberg, New York: Springer;2000; 196-212
10. 13. North KN, Korson MS, Gopal YR, Rohr FJ, Brazelton TB, Waisbren SE, et al. Neonatal-onset propionic acidemia: neurologic and developmental profiles, and implicationsfor management. J Pediatr 1995; 126; 916-922
11. 14. Sass JO, Hofmann M, Skladal D, Mayatepek E, Schwahn B, Sperl W. Propionic acidemia revisited: a workshop report. Clin Pediatr 2004; 43; 837-843
12. 15. Fenton WA, Rosenberg LE. Disorders of propionate and methylmalonate metabolism. In: Scriver CR Beaudet AL, Sly WS, Valle D (eds). The Metabolic and Molecular Bases of Inherited Disease (7th ed). New York: McGraw-Hill; 1995; 1423-451
13. 16. Matsuoka OT, Yamaguchi A, Castellanof AL, Sadeck LS, Ramos JL, Leone CR Propionic acidemia in the neonatal period. Rev Hosp Clin Fac Sao Paulo 1998; 53; 195-198
14. 17. Gebhardt B, Dittrich S, Parbel S, Vlaho S, Matsika O, Bohles H. N-carbamylglutamate protects patients with decompensated propionic aciduria from hyperammonaemia. J Inherit Metab Dis 2005; 28; 241-244 18. Bachmann C. Outcome and survival of 88 patients with urea cycle disorders: a retrospective evaluation. Eur J Pediatr 2003; 162; 410-416
15. 19. Filippi L, Gozzini E, Fiorini P, Malvagia S, la Marca G, Donati MA. N-carbamylglutamate in emergency management of hyperammonemia in neonatal acute onset propionic and methylmalonic aciduria. Neonatology 2010; 97; 286-290
16. 20. Clarke JTR. Acute metabolic illness in the newborn. In: Clarke JTR (ed). A Clinical guide to inherited metabolic disease (3th ed). Cambridge: Cambridge University Pres, 2006; 198-214
17. 21. Akman İ, İmamoglu S, Demirkol M, Alpay H, Özek E. Neonatal onset propionic acidemia without acidosis: a case report. The Turkish Journal of Pediatrics 2002; 44; 339-342
18. 22. Leonard JV, Walter JH, McKiernan PJ. The management of organic acidaemias. the role of transplantation. J Inherit Metab Dis 2001; 24; 309-311
19. 23. Gebhardt B, Vlaho S, Fischer D, Sewell A, Bohles H. N-carbamylglutamate enhances ammonia detoxification in a patient with decompensated methylmalonic aciduria. Mol Genet Metab 2003; 79; 303-304
20. 24. Gebhardt B,Dittrich S,Parbel S, Vlaho S,Matsika O,Bohles H. N-carbamylglutamate protects patients with decompensated propionic aciduria from hyperammonaemia. J Inherit Metab Dis 2005; 28; 241-244
21. 25. Schwahn BC, Pieterse L, Bisset WM, Galloway PG, Robinson PH. Biochemical efficacy of N-carbamylglutamate in neonatal severe hyperammonaemia due to propionic acidaemia.. Eur J Pediatr 2010; 169; 133-134
22. 26. Miyazaki T, Ohura T, Kobayashi M, Shigematsu Y, Yamaguchi S, Hata I, et al. Fatal propionic acidemia in mice lacking propionyl-CoA carboxylase and its rescue by postnatal, liver-specific supplementation via a transgene. J Biol Chem 2001; 276; 35995-35999