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Inborn errors of metabolism

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DisorderExamplesBasic pathophysiologyBlood gasAmmoniaGlucoseKetonesLactate
Urea cycle disordersOTC deficiencyDefect in breakdown of nitrogen → ammoniaRespiratory alkalosis/normal↑↑↑---
Amino acid disordersPKU, MSUD, homocystinuriaDefect in breakdown of amino acidsMetabolic acidosis (↑ anion gap)↑/-↑ (MSUD ↑↑↑ urinary ketones)-
Organic acid disordersPropionic, MMAAccumulation of organic acidsMetabolic acidosis (↑ anion gap)
Lysosomal storage disordersMPS, Pompe, Gaucher, Niemann-PickAccumulation of proteins/lipids-----
Glycogen storage disordersGSD types I-IXDefect in glycogen synthesisMetabolic acidosis-
Fatty acid oxidation disordersMCADD, LCADD, VLCADDUnable to break down fatty acids → ketonesMetabolic acidosis (↑ acidosis)--/↑
Mitochondrial disordersMELASInsufficient acetyl coA for Krebs cycle → ↓ ATPMetabolic acidosis--/↑-↑↑
Peroxisomal disordersXL, ADL, Refsum, Zellweger↓ metabolism of VLCFA, ↓ bile synthesis-----

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