Diagnosis of major organic acidurias in children: two years experience at a tertiary care centre

Organic acid disorders are inherited metabolic disorders in which organic acids accumulate in tissues and biological fluids of affected individuals. Classical organic acidurias include methylmalonic aciduria, propionic aciduria, isovaleric aciduria and maple syrup urine disease (MSUD). They are considered the most frequent metabolic disorders among severely ill children. Patients frequently present with acute symptoms early in life. 420 cases clinically suspected to have organic aciduria, with upper age limit of 12 years for a 2-year period (January 2007-December 2008) were enrolled into this study. Metabolic acidosis and neurological symptoms were the most common signs. Screening tests and thin layer chromatography were done for detection of organic acidurias. Identification and quantitation of organic acids in urine and quantification of amino acids in blood were done by high performance liquid chromatography. Out of 420 patients, 45 patients (10.7%) were found to have organic acidurias. 15 cases of methylmalonic aciduria, 16 cases of propionic aciduria, 13 cases of MSUD, and one case of isovaleric aciduria were diagnosed. Results demonstrate the importance of testing for organic acidurias. Since organic aciduria may cause irreversible brain damage if not treated, we recommend selective screening amongst severely ill children despite implied extra costs.

Effect of temperature and sample preparation on performance of ion-moderated partition chromatography of organic acids in biological fluids

A thorough investigation of the behavior of organic acids on the Bio-Rad Aminex cation exchange resin was prompted by both the limitations of, and a number of inexplicable inconsistencies found in, previously published papers using an identical system. In order to stabilise the elution order of various acids it was necessary to analyse samples at a higher temperature than previously recommended. This temperature (50 degrees C) decreased the retention times of all acids permitting the analysis of both aromatic and aliphatic acids within the same 45-min run. Preparation of an acidic fraction of biological fluids improved specificity, allowed direct comparison of urine and plasma profiles and by control of the conditions interference by urate could be substantially reduced. Retention data are given for more than 90 acidic metabolites including nearly 40 of clinical significance and a number derived from diet and drug therapy.