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Under the condition of stress reactions such as fever, infection, or increased metabolic stress, patients with methylmalonic acidemia may manifest symptoms of acute metabolic decompensation such as impaired level of consciousness, hypotonia complicated by hyperammonemic encephalopathy, respiratory distress, acidosis, etc

Thus, while acute LC supplementation may confer immediate physiological benefits, chronic elevations in TMAO levels warrant careful risk evaluation due to their association with adverse cardiovascular outcomes, particularly in vulnerable populations

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