title: [Severe fulminant form of neonatal citrullinemia. Report of a case].
abstract: BACKGROUND
  Citrullinemia is an autosomal recessive disease, which is caused by a deficiency of the argininosuccinate synthetase. The neonatal forms are serious and many times are associated with a high level of mortality.
  
  
  METHODS
  A newborn that came in again on her third day of life due to a apneic episodes which required mechanical ventilation. Previously, she rejected feeding, had poor suction, lethargy and remarkable hypoactivity. During the following hours, she showed serious neurologycal deterioration with multifocal convulsions and coma, passing away 20 hours after admission due to endocraneal hypertension. The metabolic evaluation confirmed very significant hyperammonemia, with important increase of citrullin and glutamin, and arginine in the low limits of normality. She was treated with sodium benzoate and arginine and she also needed exanguinotransfusion. It was not possible to put her on hemodyalisis. The findings of the autopsy confirmed massive cerebral edema and characteristic hystological changes in the liver. The determination of the enzymatical activity in liver tissue showed a partial deficiency, with a residual activity of 25% of the average control.
  
  
  CONCLUSIONS
  This is a case of fulminant neonatal citrullinemia that we considered of interest in order to draw the attention of the clinical on this type of diseases. The prognosis depends on early diagnosis, witch is based on clinical suspicion and analytical determination of ammonia in every newborn with unexplained vomiting, lethargy or other symptoms of encephalopathy.
authors.affiliation: Unidad Neonatal, Hospital Universitario Miguel Servet, Zaragoza, España.
authors.forename: P
authors.initials: P
authors.lastname: Lalaguna-Mallada
authors.forename: R
authors.initials: R
authors.lastname: García-Romero
authors.forename: B
authors.initials: B
authors.lastname: Alonso-del Val
authors.forename: S
authors.initials: S
authors.lastname: Rite-Gracia
authors.forename: J
authors.initials: J
authors.lastname: Lopez-Pisón
authors.forename: A
authors.initials: A
authors.lastname: Baldellou-Vázquez
authors.forename: M I
authors.initials: MI
authors.lastname: Salazar García-Blanco
authors.forename: C
authors.initials: C
authors.lastname: Yus-Gotor
authors.forename: P
authors.initials: P
authors.lastname: Briones-Godino
authors.forename: A
authors.initials: A
authors.lastname: Marco-Tello
authors.forename: V
authors.initials: V
authors.lastname: Rebage
mesh_terms: D000328:Adult; D000641:Ammonia / Q000097:blood; D002648:Child; D002956:Citrulline / Q000097:blood; D020159:Citrullinemia / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology*; D017809:Fatal Outcome; D005260:Female; D005973:Glutamine / Q000097:blood; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008099:Liver / Q000201:enzymology; D011379:Prognosis
chemical_list: D005973:Glutamine; D002956:Citrulline; D000641:Ammonia