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On day seven, further metabolic testing revealed elevated plasma propionylcarnitine at 27.24 mol/L (0.180.89 mol/L, liquid chromatography-tandem mass spectrometry, SCIEX 6500, Agilent), increased plasma acetylcarnitine at 18.48 mol/L (3.6012.55 mol/L), and urine methylmalonic acid at 12.7 nmol/L (04 nmol/L