Organic acidurias are an important class of inherited metabolic disorders arising due to defect in intermediary metabolic pathways of carbohydrate, amino acids and fatty acid oxidation. This review summarizes the current knowledge about the important organic acidurias in the Indian population. Specifically, diagnosis and principles of treatment of organic acidurias are covered. The salient features of common organic acidurias as well as their prevalence in various parts of the world are reviewed in some detail.

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.

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The term "organic acidemia" or "organic aciduria" (OA) applies to inborn errors of metabolism (IEM) in which organic acids accumulate in tissues and biological fluids. Classical organic acidurias include methylmalonic aciduria (MMA), propionic aciduria (PA), isovaleric aciduria (IVA) and maple syrup urine disease (MSUD). Aminoacidurias like phenylketonuria are common in the western population. Organic acidemias like MMA, PA and MSUD are more common in Asian countries, especially in India compared with the west. This study was conducted to determine the prevalence and treatment outcome of organic acidemias in a study population in India. Four hundred and twenty suspected cases of organic acidemias with an upper age limit of twelve years were enrolled over a two years period beteween January, 2007 and December, 2008, with a three years patient follow-up. Screening tests and thin layer chromatography followed by quantification of organic acids in urine and quantification of amino acids in blood by high performance liquid chromatography were done for detection of organic acidemias. Out of 420 patients, 45 patients (10.7%) were found to have organic acidemias, 15 cases of MMA, 16 cases of PA, 13 cases of MSUD, and one case of IVA were identified. Fifteen patients (33.3%) died during the course and remaining 30 are under therapeutic regimen and showed marked clinical improvement. Therapeutic regimens based on protein restriction, sodium bicarbonate (to correct acidosis), L-carnitine and vitamins were given to the patients. Prompt diagnosis helped to provide specific treatment to majority of these patients with rapid improvement in symptomatology.