Abstract
Disorders of fatty acid oxidation are rare but can be fatal. Hypoglycaemia with acidosis is a cardinal feature. Cases may present during early childhood or can be delayed into adolescence or beyond. We present a case of multiple acyl-coenzyme A dehydrogenase deficiency (MADD), an extremely rare disorder of fatty acid oxidation. Our 20-year-old patient presented with cardiovascular collapse, raised anion gap metabolic acidosis and non-ketotic hypoglycaemia. She subsequently developed multi-organ failure and sadly died. She had a previous diagnosis of cyclic vomiting syndrome (CVS) for more than 10 years, warranting frequent hospital admissions. The association between CVS and MADD has been made before though the exact relationship is unclear. All patients with persistent severe CVS should have metabolic investigations to exclude disorders of fatty acid oxidation. In case of non-ketotic hypoglycaemia with acidosis, the patient should be urgently referred to a specialist in metabolic diseases. All practitioners should be aware of these rare disorders as a cause of unexplained acidosis.
Similar content being viewed by others
References
Barić I, Zschocke J, Christensen E, Duran M, Goodman SI, Leonard JV, Müller E, Morton DH, Superti-Furga A, Hoffmann GF (1998) Diagnosis and management of glutaric aciduria type I. J Inherit Metab Dis 21(4):326–340
Fitzpatrick E, Bourke B, Drumm B, Rowland M (2008) The incidence of cyclic vomiting syndrome in children: population-based study. Am J Gastroenterol 103:991–995
Gempel K, Topaloglu H, Talim B, Schneiderat P, Schoser BG, Hans VH, Pálmafy B, Kale G, Tokatli A, Quinzii C, Hirano M, Naini A, DiMauro S, Prokisch H, Lochmüller H, Horvath R (2007) The myopathic form of coenzyme Q10 deficiency is caused by mutations in the electron-transferring–flavoprotein dehydrogenase (ETFDH) gene. Brain 130(Pt 8):2037–2044
Lee HC, Lai CK, Siu TS, Yuen YP, Chan KY, Chan AY, Tam S, Mak CM, Lam CW (2010) Role of post-mortem genetic testing demonstrated in a case of glutaric aciduria type II. Diagn Mol Pathol 19(3):184–186
Li BU, Murray RD, Heitlinger LA, Robbins JL, Hayes JR (1998) Heterogeneity of diagnoses presenting as cyclic vomiting. Pediatrics 102(3 Pt 1):583–587
Lund AM, Skovby F, Vestergaard H, Christensen M, Christensen EJ (2010) Clinical and biochemical monitoring of patients with fatty acid oxidation disorders. Inherit Metab Dis 33(5):495–500
McLoughlin LM, Trimble ER, Jackson P, Chong SK (2004) l-Carnitine in cyclical vomiting syndrome. Arch Dis Child 89(12):1180
Olsen RKJ et al (2007) ETFDH mutations as a major cause of riboflavin-responsive multiple acyl-CoA dehydrogenation deficiency. Brain 130:2045–2054
Rinaldo P (1999) Mitochondrial fatty acid oxidation disorders and cyclic vomiting syndrome. Dig Dis Sci 44(8 Suppl):97S–102S
Van Calcar SC, Harding CO, Wolff JA (2002) l-Carnitine administration reduces number of episodes in cyclic vomiting syndrome. Clin Pediatr (Phila) 41(3):171–174
Acknowledgements
We thank Professor Billy Bourke, the consultant paediatric gastroenterologist of Our Lady's Children's Hospital, Crumlin, Dublin 12; Professor Kieran Sheehan, the consultant pathologist of St Vincent's University Hospital; and Professor Michael Farrell, the consultant neuropathologist of Beaumont University Hospital, Dublin 9. We would also thank the institutions where the work was performed, namely St Vincent's University Hospital, Elm Park, Dublin 4, Ireland and National Centre for Inherited Metabolic Disorders, the Children's University Hospital, Dublin, Ireland.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Fitzgerald, M., Crushell, E. & Hickey, C. Cyclic vomiting syndrome masking a fatal metabolic disease. Eur J Pediatr 172, 707–710 (2013). https://doi.org/10.1007/s00431-012-1852-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00431-012-1852-z