How to treat phenylketonuria?

Written by Yan Xin Liang
Pediatrics
Updated on July 01, 2025
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Phenylketonuria is one of the few treatable hereditary metabolic disorders. We must strive for early diagnosis and treatment to avoid irreversible damage to the nervous system. Once diagnosed, active treatment should be given, and the younger the age at which treatment begins, the better. The treatment mainly uses a low-phenylalanine milk formula. Once the blood concentration is reduced to the ideal level, natural foods can gradually be added in small quantities, with breast milk being the preferred choice. For older infants and young children, milk, porridge, noodles, eggs, etc., can be added. The addition of food should follow the principle of low-protein and low-phenylalanine, with the amount and frequency depending on the phenylalanine concentration. Both high and low concentrations of phenylalanine can affect growth and development. Since each child's tolerance to phenylalanine varies, it is also necessary to regularly measure blood phenylalanine levels during dietary treatment and adjust the diet according to the specific conditions of the child.

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Written by Yao Li Qin
Pediatrics
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Is phenylketonuria often misdiagnosed?

Phenylketonuria belongs to congenital hereditary metabolic disorders and is caused by enzyme deficiencies in the phenylalanine metabolic pathway. Misdiagnosis of phenylketonuria is not common; if the disease develops, meaning that the child has typical clinical manifestations, it is relatively easy to diagnose. However, once a child exhibits the typical clinical manifestations of phenylketonuria such as blood phenylalanine levels, by the time of diagnosis the child may already have varying degrees of neurological damage, meaning the child might already have intellectual disabilities. Therefore, in such cases, we cannot rely solely on clinical symptoms for diagnosis but should instead carry out newborn disease screening promptly after birth. By diagnosing and treating before any clinical symptoms appear, we can prevent the occurrence of neurological complications, allowing the child to grow and develop like a normal child.

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Written by Yan Xin Liang
Pediatrics
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Causes of Phenylketonuria

The cause of phenylketonuria is that phenylalanine is an essential amino acid for the human body. Some of the phenylalanine ingested is used for protein synthesis, while another part is converted into tyrosine by the action of phenylalanine hydroxylase. Only a small amount of phenylalanine undergoes a secondary metabolic pathway and is converted into phenylpyruvate under the action of transaminase. Due to the reduced activity of phenylalanine hydroxylase in affected children, phenylalanine cannot be converted into tyrosine, leading to an extremely high concentration of phenylalanine in blood, cerebrospinal fluid, and tissues. This, through a bypass metabolic pathway, results in the production of a large amount of phenylpyruvate, phenylacetate, phenyllactate, and p-hydroxyphenylacetate. The high concentration of phenylalanine and its metabolic products then leads to brain damage, which is the cause of the disease.

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Written by Hu Qi Feng
Pediatrics
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Mechanism of phenylketonuria

Phenylketonuria is characterized by reduced activity of phenylalanine hydroxylase, which fails to convert phenylalanine to tyrosine, causing extremely elevated levels of phenylalanine in the blood, cerebrospinal fluid, and tissues. This leads to the production of large amounts of phenylpyruvic acid, phenylacetic acid, phenyllactic acid, and p-hydroxyphenylacetic acid via alternative pathways. High concentrations of phenylalanine and its metabolic products can cause brain damage, which manifests as developmental intellectual disabilities, changes in skin and hair pigmentation, and a mousy urine odor, all part of a clinical syndrome.

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Written by Zeng Hai Jiang
Pediatrics
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When do people with phenylketonuria need to eat a special diet until?

Phenylketonuria is the first genetic metabolic disease that can be treated through dietary control. Since natural foods contain certain amounts of phenylalanine, once children with phenylketonuria are diagnosed, they should stop consuming a natural diet and start a low-phenylalanine diet treatment. Treatment with a low-phenylalanine formula should continue at least until the age of 12. When the concentration of phenylalanine in the blood is controlled at an ideal level, gradually small amounts of natural diet can be reintroduced. The food added should adhere to the principles of being low in protein and phenylalanine.

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Written by Zeng Hai Jiang
Pediatrics
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Can phenylketonuria be breastfed?

Once a child with phenylketonuria is diagnosed, natural diets should be ceased and a low-phenylalanine diet treatment should be initiated. Treatment with a low-phenylalanine formula should continue at least until the age of 12. Breast milk is the ideal natural food for infants; therefore, although breastfeeding should be temporarily halted after diagnosis, it should not be completely stopped so that it can be promptly reintroduced once blood phenylalanine levels are controlled. When blood phenylalanine levels are controlled to an ideal concentration, gradually reintroduce small amounts of natural diet, preferably starting with breast milk, as it contains only one-third the phenylalanine content of cow's milk.