We describe the lysine restricted, dietary management of three out of four siblings who were identified as having hyperlysinaemia. The diets, started in the neonatal period, were maintained for varying periods with unpredictable success. The propositus, who was not treated, was diagnosed at the age of 5 years, by which time he was already severely handicapped, presumably because of his metabolic disorder. Tentative recommendations are put forward for the management of this seemingly rare disorder. Mild chronic ammonia toxicity may be a factor in the pathogenesis of this condition.
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