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Inborn errors of metabolism (IEMs) encompass deficiencies of enzymes or cofactors that normally aid in the breakdown of carbohydrates, proteins, fats, and other molecules. These defects can cause a buildup of potentially toxic metabolites and a defect in energy production, most commonly leading to hypoglycemia, hyperammonemia, and/or anion gap metabolic acidosis. State newborn screening programs aid in the early diagnosis and treatment of many, but not all, of these illnesses. A patient with an IEM is at highest risk for morbidity or mortality when caloric intake (especially glucose) is poor or when there is an intercurrent illness. They are then...

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