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Ethylmalonic acid is a dicarboxylic acid and metabolite of the essential amino acid L-isoleucine and branched-chain amino acid L-alloisoleucine (Item No. 34904).1 It is formed from L-isoleucine and L-alloisoleucine via an R-2-oxo-3-methylvaleric acid intermediate. Urinary levels of ethylmalonic acid are increased in patients with ethylmalonic encephalopathy, an inborn error of metabolism characterized by developmental delay, hypotonia, vascular instability, petechiae, acrocyanosis, chronic diarrhea, and lactic acidemia. Urinary levels of ethylmalonic acid are also increased in patients with short-chain acyl-CoA dehydrogenase deficiency.2
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1. Ethylmalonic and methylsuccinic aciduria in ethylmalonic encephalopathy arise from abnormal isoleucine metabolism. Metabolism 47(7), 836-839 (1998).
2. Biochemical, molecular, and clinical characteristics of children with short chain acyl-