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Nutrition Interventions for Children with Special Health Care Needs

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Adjunct<br />

treatment<br />

Biochemical features <strong>Nutrition</strong>al<br />

treatment<br />

Disorder Enzyme: missing<br />

or inactive<br />

L-carnitine,<br />

phenylbutyrate, †<br />

L-arginine<br />

Food: low protein<br />

� plasma citrulline, ammonia,<br />

alanine<br />

Citrullinemia Argininosuccinate<br />

synthetase<br />

Formula: <strong>with</strong>out nonessential<br />

amino acids<br />

Neonatal: vomiting; seizures;<br />

coma � death<br />

Infantile: vomiting; seizures;<br />

progressive developmental<br />

delay<br />

L-carnitine,<br />

phenylbutyrate, †<br />

L-citrulline, L-arginine<br />

Food: low protein<br />

Vomiting; seizures; sometimes<br />

coma � death<br />

Carbamyl phosphate<br />

synthetase<br />

Carbamyl phosphate<br />

synthetase deficiency<br />

Formula: <strong>with</strong>out nonessential<br />

amino acids<br />

Section 3 - Condition-Specific <strong>Nutrition</strong> <strong>Interventions</strong><br />

Survivors usually have MR, �<br />

plasma ammonia, glutamine<br />

Hemodialysis or peritoneal<br />

dialysis during acute<br />

episodes<br />

L-carnitine,<br />

phenylbutyrate, †<br />

L-arginine<br />

<strong>Nutrition</strong> <strong>Interventions</strong> <strong>for</strong> <strong>Children</strong> With <strong>Special</strong> <strong>Health</strong> <strong>Care</strong> <strong>Needs</strong> 241<br />

Food: low protein<br />

Argininosuccinic aciduria Argininosuccinate lyase � plasma argininosuccinc acity,<br />

citrulline, ammonia<br />

<strong>Special</strong>ized <strong>for</strong>mula: lower<br />

protein <strong>with</strong>out nonessential<br />

amino acids<br />

Neonatal: hypotonia; seizures<br />

Subacute: vomiting; FTT,<br />

progressive developmental<br />

delay<br />

L-carnitine,<br />

phenylbutyrate †<br />

Food: low protein<br />

Arginase deficiency Arginase Periodic vomiting; seizures;<br />

coma<br />

<strong>Special</strong>ized <strong>for</strong>mula: lower<br />

protein <strong>with</strong>out nonessential<br />

amino acids<br />

Progressive spastic diplegia,<br />

developmental delay<br />

� arginine, ammonia <strong>with</strong><br />

protein intake

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