LESSONS FROM THE LATE DIAGNOSIS OF ISOVALERIC ACIDEMIA IN A 5-YEAR-OLD BOY

Chronic, intermittent isovaleric acidemia was undiagnosed in a boy wit h an increased anion gap metabolic acidosis until the boy was 5 years of age, This case emphasizes the importance of maintaining a high inde x of suspicion for inborn errors of metabolism in patients with metabo lic acidosis, even in late childhood.