Hypoketotic hypoglycemic coma in a 21-month-old child

Laryngeal edema and metabolic acidosis after Omnicide ingestion

INTRODUCTION

Glutaraldehyde and quaternary ammonium compounds are widely used as disinfectants and sterilizing agents. Glutaraldehyde is irritating to the eyes and upper respiratory tract, and has been associated with occupational asthma. Acute oral ingestion of a concentrated solution has not been previously reported in humans.

CASE REPORT

A 19-year-old woman presented after deliberate ingestion of a biocide containing glutaraldehyde and a quaternary ammonium compound. She developed respiratory distress and severe metabolic acidosis 10 hours after admission. Marked laryngeal edema was noted when she was being intubated. She eventually improved following supportive care and was discharged alive after 9 hospital days.

DISCUSSION

There are no reports of acute ingestions of both glutaraldehyde and quaternary ammonium compounds. As both these substances are known to cause metabolic acidosis, localized edema, erosion and sensitization of both the respiratory and alimentary tract. The clinical effect may be additive or synergistic.

CONCLUSIONS

Omnicide ingestion should be closely monitored for metabolic acidosis and laryngeal edema which may progress to upper airway obstruction requiring urgent airway stabilization.

Role of short-chain hydroxyacyl CoA dehydrogenases in SCHAD deficiency

Short-chain hydroxyacyl CoA dehydrogenase deficiency is an ill-defined, severe pediatric disorder of mitochondrial fatty acid beta-oxidation of short-chain hydroxyacyl CoAs. To understand the relative contributions of the two known short-chain hydroxyacyl CoA dehydrogenases (HADH) tissue biopsies of six distinct family individuals were analyzed and kinetic parameters were compared. Steady-state kinetic constants for HADH 1 and HADH 2 suggest that type 1 is the major enzyme involved in mitochondrial beta-oxidation of short-chain hydroxyacyl-CoAs. Two patients are heterozygous carriers of a HADH 1 polymorphism, whereas no mutation is detected in the HADH 2 gene of all patients. The data suggest that protein interactions rather than HADH mutations are responsible for the disease phenotype. Pull-down experiments of recombinant HADH 1 and 2 with human mitochondrial extracts reveal two proteins interacting with HADH 1, one of which was identified as glutamate dehydrogenase. This association provides a possible link between fatty acid metabolism and the hyperinsulinism/hyperammonia syndrome.

Inherited disorders of mitochondrial fatty acid oxidation: a new responsibility for the neonatologist

The disorders of mitochondrial fat oxidation present clinically with three major clinical phenotypes: hypoketotic hypoglycemia, cardiomyopathy, and myopathy. Although these features can present together in some of the disorders, one will be the dominant clinical problem. This review will describe these clinical phenotypes while addressing the diagnostic value of various clinical and laboratory studies which are often used for making these diagnoses. With knowledge of the clinical presentation, these diagnoses can often be made very rapidly and at relatively low cost by more specific laboratory tests. The increasing availability of expanded newborn screening by tandem mass spectrometry as well as prenatal diagnosis for these often fatal disorders now provides the opportunity for pre-symptomatic diagnosis. The neonatologist is now in the unique position of identifying these inherited disorders prior to or during severe symptom onset and has the earliest opportunity to provide successful treatment intervention.