Metabolic
decompensations can be triggered by infections, surgical
intervention, dehydration, or excessive protein intake (1,7). A
study by Grünert et al (8) demonstrated that gastroenteritis is
the most common trigger, while protein excess or surgery did
not play a major role as a precipitating factors. The first attack of
metabolic crisis in our patient occurred at the age of two years
and was triggered by a gastrointestinal infection. It is thought to
be secondary to a viral infection. Stool examination for rotavirus
antigen was negative. We could not identify the pathogen