Enzyme Deficiency Underlying a Newborn with Characteristic Maple Syrup Odor

A 6-day-old newborn is brought to the neonatal intensive care unit due to poor feeding, lethargy, and episodes of vomiting. The infant's parents report that the urine has a distinctive sweet, maple syrup-like odor. Laboratory evaluation reveals metabolic acidosis along with elevated levels of branched-chain amino acids and their corresponding ketoacids in the blood. Which enzyme deficiency is most consistent with this patient's clinical presentation?

Vital Signs:

  • Temperature: 36.8°C (98.2°F)
  • Heart Rate: 140/min
  • Respiratory Rate: 45/min

Laboratory Findings:

  • Metabolic acidosis with an increased anion gap
  • Elevated branched-chain amino acids (leucine, isoleucine, valine)
  • Accumulation of corresponding α-ketoacids

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