ORGANIC ACID
Organic Acid
Testing the metabolic processes in the body
The term 'organic acid' includes a broad group of substances that are used in basic metabolic processes in the body. Among the organic acids, neurotransmitter metabolites and metabolites fall from the breakdown of fats, carbohydrates and proteins to energy. Chemically, the organic acids have in common that they are water-soluble, acidic and ninhydrin-negative (which means that amino acids are usually excluded from this group). The level of the organic acids in the urine is relatively high, so that a large number of organic acids can be detected and determined in the urine. The level of the organic acids in the first morning urine (from before something is eaten or drunk) in relation to the creatinine level in the same urine (mmol organic acid / mole creatinine) gives a good picture of the status of the organic acids.
Traditionally, organic acid analyzes in urine are only performed to detect serious congenital abnormalities in metabolism, such as phenylketonuria (PKU) and maple sirup urinary disease. However, the value of the organic acid analyzes is not limited to this.
Because organic acids are part of a very large number of fundamental metabolic processes, organic acid analyzes can be used for (early) detection of a whole range of 'blockades' in metabolism. Many such blockades - which manifest themselves in disturbances in organic acid levels - are caused or partly caused by insufficient availability of certain nutrients; such as due to the availability of insufficient nutrients (vitamins and / or minerals) that are necessary as cofactors of the enzymes necessary for the conversion (eg biotin, vitamin B1, B2, B3, B5, B6, C, folic acid, manganese, iron, etc.). magnesium, lipoic acid and coenzyme Q10). Disturbances in organic acid levels can therefore be partially treated with nutrients.
In addition to organic acids from the metabolism of humans themselves, organic acids that originate from (pathogenic) microorganisms from the gastrointestinal tract can also be detected in the urine. Such organic acids provide information about possible disturbances of the intestinal flora and also have clinical relevance because they can often lead to complaints after admission to the bloodstream (for example because they act as anti-metabolic toxins).
The WHL offers the following balanced package with organic acid more than 70 determinations in urine:
WHEN TO MAKE MEANINGFUL DETERMINING OF ORGANIC ACID IN URINE?
With the aid of the analysis the following disturbances can be detected.
- Disturbances in the metabolism of the aromatic amino acids: (Phenylketonuria, tyrosinemia, Hawkinsuria, Alcaptonuria).
- Disruptions in the metabolism of the branched chain amino acids (Maple syrup urine disease, isovaleric acidemia, methylcrotonylglycinuria, biotin-responsive multiple carboxylase deficiency, methylglutaconic aciduria, 3-hydroxy-3-methyl glutaric aciduria, 3-ketothiolase deficiency, propionic acidemia, methylmalonic acid acidemia).
- Disruptions in the metabolism of other amino acids: (ketoadipic acid aciduria, glutaric aciduria type I and II, 5-oxoprolinuria, ornithine transcarbamylase deficiency, citrullinemia, arginosuccinic aciduria, arginemia, Canavan disease, methioninemia).
- Disturbances in purine metabolism (Lesch-Nyhan syndrome).
- Disruptions in the pyrimidine metabolism (orotic acidemia).
- Disruptions in cholesterol synthesis (mevalonic acidemia).
- Disruptions in fatty acid oxidation: (short, medium and long chain fat acyl dehydrogenase (SCAD, MCAD and LCAD) deficiency, multiple acyl dehydrogenase (MAD) deficiency, long chain 3-hydroxyacyl dehydrogenase deficiency).
- Other combined disorders: (Glutathione synthetase deficiency, fumarase deficiency, succinic semialdehyde dehydrogenase deficiency with lactic acidosis, malonyl CoA carboxylase deficiency, 2-ketoadipic acidemia, glutaric acidemia type I, pyruvate dehydrogenase E1 and E2 subunit deficiency, dihydrolipoyl dehydrogenase deficiency, biotinidase deficiency , alphaketoglutaric acidemia, pyruvic acid dehydrogenase phosphatase deficiency, primary hyperoxaluria type I and II, Oasthouse urinary disease (methionine malabsorption syndrome), Hartnup's disease, fructose 1,6 diphosphatase deficiency, ethylmalonic acid adipic acidemia, neuroblastoma, carcinoid syndrome, pheochromacytoma).
- Disorders related to lactic acidemia and / or pyruvic acidemia in which other organic acids are not characteristically elevated: (pyruvic acid carboxylase deficiency (neonatal or infantile forms), phosphoenol pyruvic acid carboxykinase deficiency, NADH-CoQ oxidoreductase (complex I) deficiency, ubuquinol cytochrome C reductase (complex III) deficiency, cytochrome oxidase (complex IV) deficiency, myoclonic epilepsy with ragged red fibers (MERRF), mitochondrial encephalomyopathy lactic acidosis with stroke-like episodes (MELAS), Kearns-Sayre syndrome).
An organic acid analysis is indicated for the following complaints:
- Serious, unusual or recurrent symptoms for which no cause has been found.
- Frequent infections and / or a failing immune system.
- SIDS (sudden infants death syndrome), almost SIDS or a history with SIDS or almost SIDS.
- Lethargy, coma, Reye syndrome.
- Periods with apnea or heart-respiratory 'arrest'.
- Alopecia (baldness due to hair loss) and / or severe dermatitis, including peripheral neuropathy.
- Striking aversion to protein-rich food, such as meat, fish and milk products and / or a history of nausea and vomiting after intake of proteins.
- Prolonged, unexplained periods of nausea and vomiting.
- Juvenile arthritis and / or pain in the joints that is not the result of autoimmune disease.
- Psychosis, autism and other serious behavioral disorders.
- Remarkable body odor or urine smell or abnormally colored (black, blue, red or green) urine.
- Hepatomegaly.
- Abnormal blood clotting or dispersed intravascular coagulation that can not be explained by a shortage of known clotting factors or other disease states, such as lupus.
- Severe long-term constipation or diarrhea that can not be attributed to a disease condition.
An organic acid analysis is also indicated when the following abnormal laboratory values have been found:
- Increased glucose in non-diabetic patients.
- Low glucose.
- High normal ammonia value or an abnormal increase in the ammonia value.
- Low BUN (blood urea nitrogen).
- Increased lactic acid.
- Increased serum uric acid.
- Increased anion gap.
- The presence of uric acid crystals in the urine
- Increased ketones.
- Severe anemia.
- Immune deficiencies of which the cause is unknown.
- CPK values that are many times the upper limit of the normal range.
- Triglycerides values of 800 mg / dl or more.
- Serum cholesterol higher than 250 mg / dl or less than 50 mg / dl.
- Low blood pH without a clear cause being known.
- The organic acid analysis can be combined with an amino acid analysis.
LITERATURE:
1. William Shaw. Biological treatment for Autism end PDD. Chapter 3. Organic acid testing, byproducts of yeast and their relationship to autism. 1998 William Shaw Ph.D., USA.