Organic Acids (OAT) Review

What's in the procedure

The full procedure the skill follows in Meelio, as published in the open source repo.

Decision support for licensed healthcare professionals. Analysis only — the practitioner reviews, verifies, and decides.

Gather context (before interpreting anything)

1. Call get_patient_documents to locate the OAT report (category lab_report) and its structured labFindings[], and search_patient_documents for the raw report text — OAT ranges are age-adjusted and creatinine-corrected, and the lab's own commentary matters; extraction alone loses it. If no OAT exists in the record, say so and stop.
2. Call get_patient_snapshot for demographics (age — ranges are age-specific), medicalHistory (conditions, medications — SSRIs, recent antibiotics/antifungals; supplements — vitamin C, probiotics, MCT, 5-HTP/tryptophan), dietAndLifestyle (fruit intake, fasting patterns), and recentEncounters for the clinical question (fatigue, mood/behavior, suspected candida, chronic pain).
3. Date by specimen/collection date (eventDate). If a GI-MAP or prior OAT exists in the documents, plan to cross-reference (see synthesis).
4. Skip anything marked contradicted. If history was truncated, write "history shown may be incomplete" — never "no history".

Interpretation procedure

Interpret by block, then synthesize. Single OAT markers are weak evidence; convergent patterns across blocks are the signal.

1. Collection validity and the right reference bracket. Non-first-morning collection, high fruit intake in the prior 48 h (falsely raises arabinose and furans), vitamin C supplementation (oxalate/ascorbate pathways), and recent antibiotics reshape the profile — state applicable caveats from the chart before interpreting. Confirm the age bracket the ranges were applied against (demographics.age; OAT ranges are age-specific and creatinine-corrected); much of the marker literature is pediatric, so extrapolation to adults carries extra uncertainty — say so when it applies. In pregnancy and in athletes/ketogenic or fasted states (dietAndLifestyle), energy-metabolite and ketone blocks shift physiologically — interpret against that context rather than as pathology.
2. Yeast/fungal markers. Arabinose is the workhorse candida marker (with citramalic, tartaric, and furan compounds). Elevations suggest fungal overgrowth after diet is excluded; correlate with documented signs and any GI-MAP in the record (stool candida is insecure — OAT and GI-MAP together beat either alone). Tricarballylic relates to fusarium/mold exposure context.
3. Bacterial and Clostridia markers. General bacterial: elevated hippuric, 2-hydroxyphenylacetic, 4-hydroxybenzoic; DHPPA-type markers reflect beneficial flora. Clostridia block is priority: HPHPA and 4-cresol elevations inhibit dopamine-β-hydroxylase — check the neurotransmitter block for high HVA with low-normal VMA (high HVA:VMA). Marked elevations with behavioral/neurological symptoms deserve stool confirmation.
4. Oxalates. High oxalic with high glyceric or glycolic suggests genetic hyperoxaluria (conventional referral — see red flags). High oxalic alone: dietary load (spinach, almonds), fungal contribution (cross-check block 2), fat malabsorption, low B6, or high-dose vitamin C. Correlate with any kidney-stone history in the chart.
5. Mitochondrial/Krebs block. Elevated citric, aconitic, 2-oxoglutaric, succinic, fumaric, malic = impaired energy metabolism read as a pattern (multiple intermediates up = functional bottleneck; which ones hint at cofactor needs — B-vitamins, magnesium, CoQ10, carnitine). 3-methylglutaric/3-hydroxy-3-methylglutaric relate to HMG/CoQ10 pathway stress. Correlate with documented fatigue.
6. Neurotransmitter metabolites. HVA (dopamine turnover), VMA (norepinephrine/epinephrine), HVA:VMA ratio (elevated → DBH inhibition — Clostridia, copper status, vitamin C); 5-HIAA (serotonin turnover — SSRIs and 5-HTP/tryptophan in the med list shift it; note interference); quinolinic and kynurenic (inflammation-shifted tryptophan metabolism — high quinolinic:5-HIAA suggests neuroinflammatory pressure).
7. B-vitamin, methylation, and detox markers. Methylmalonic (functional B12 — cross-check serum B12 in labResults), FIGLU (folate), xanthurenic/kynurenic (B6), 3-hydroxyisovaleric (biotin), pantothenic (B5), glutaric (B2/carnitine); pyroglutamic as glutathione-depletion signal; orotic (ammonia/urea-cycle stress — marked elevation is a conventional finding); 8-OHdG where reported (oxidative DNA stress).
8. Fatty-acid oxidation block. Adipic, suberic, sebacic, ethylmalonic, methylsuccinic — carnitine/riboflavin-dependent β-oxidation inefficiency vs fasting/MCT intake; distinguish using dietAndLifestyle and the supplement list.
9. Synthesis. Name convergent stories tied to the chart: candida block + oxalates + documented GI symptoms; Clostridia markers + high HVA:VMA + behavioral symptoms; Krebs + FA-oxidation elevations + fatigue (mitochondrial support picture); quinolinic shift + pyroglutamate + chronic inflammation. Cross-reference the GI-MAP where present. State confidence honestly — the OAT is a screening/pattern tool; recommend confirmation where a finding would change management.

Red flags — escalate regardless of functional interpretation

Not exhaustive. High oxalic with elevated glyceric or glycolic (possible primary hyperoxaluria — nephrology/genetics referral); markedly elevated orotic acid (urea-cycle evaluation, especially with protein intolerance or neurological symptoms); patterns suggesting an inborn error of metabolism in a child (multiple extreme elevations across Krebs/FA-oxidation blocks — metabolic specialist referral); severe unexplained neurological or behavioral deterioration warrants conventional workup independent of any OAT finding. Put these first in the output.

Output format

1. Snapshot — one paragraph: dominant pattern and the single most important finding.
2. Validity notes — diet/supplement/collection caveats from the chart, stated first.
3. Findings by block — table: Block | Marker | Value | Age-adjusted range | Flag | Note.
4. Pattern synthesis — convergent stories across blocks and against the GI-MAP where present, with confidence stated.
5. Red flags — or an explicit "none identified against the checked list".
6. Considerations for the practitioner — confirmatory testing (stool testing, serum B12/MMA, RBC nutrients), cofactor-support directions as options, retest timing (typically 3–6 months). Options, never directives.
7. Patient-friendly summary — only if asked.

If the practitioner wants it saved, save with create_note (a lab review is not a clinical note or care plan).

End with: "Decision support only — for review by the treating clinician."

Evidence & sources

Ranges are the performing lab's age-bracketed, creatinine-corrected reference sets (Mosaic Diagnostics, formerly Great Plains) — always attributed to the lab. Evidence tiers are stated honestly in the body: nutrient-functional markers (methylmalonic acid for B12, FIGLU for folate, xanthurenic for B6) and the inborn-error red flags (glyceric/glycolic for primary hyperoxaluria, orotic acid for urea-cycle stress) rest on established biochemical genetics and are the strongest part of the test; dysbiosis markers (arabinose, HPHPA, 4-cresol) rest largely on small, lab-affiliated studies, and the dopamine-β-hydroxylase inhibition story is mechanistic with limited clinical validation — which is why the skill treats the OAT as a screening/pattern tool, requires convergence across blocks, and recommends confirmation before anything would change management.

Changelog

• 1.0.1Added age-bracket/reference verification, pregnancy and athlete/ketogenic context, and evidence tiering.
• 1.0.0Initial version.

Patient data on each platform

De-identification means removing all 18 HIPAA identifiers, not just the name. Read the full disclaimer.