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For any type of surgery, prevention of a metabolic decompensation as a result of the stress of surgery should be undertaken prior to surgery by providing adequate hydration prior to and after surgery, avoiding prolonged fasting to the extent possible, addressing pain issues, and providing adequate calories to promote fast healing

Impairment of excretion of AC occurs with deteriorating renal function leading to decreased carnitine clearance and resulting in elevated plasma levels of carnitine [13]

To further confirm the diagnosis, the levels of organic acids in urine were measured with GC/MS in patients with suspected MMA

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