Go through these in order and stop at the first one that applies. If you are reading this for someone else, answer for them.
1
Is any of this happening now?
Call 911
Call emergency services for a seizure, collapse, loss of consciousness, or difficulty waking the person.
Bring the emergency letter and tell staff that MMA can cause metabolic acidosis and high ammonia.
Other emergency signs, for anyone
Someone who is struggling to breathe, gasping, choking, or cannot get words out
Someone who has chest pain, tightness or pressure lasting more than a few minutes
Someone who has sudden weakness or drooping on one side of the face or body, slurred speech, or sudden confusion
Someone who is unconscious, or cannot be woken
Someone who is bleeding heavily and it will not stop with firm pressure
Someone who has had a seizure that will not stop, or does not wake up afterwards
Someone who has lips or skin that look pale, blue, grey or blotchy
Someone who you believe has taken an overdose or swallowed something poisonous
2
Is any of this happening?
Be seen today
Contact the metabolic team promptly for fever, reduced appetite, diarrhea, repeated vomiting, or difficulty following the usual feeding plan.
Early advice may prevent deterioration, even if the person is still alert and drinking.
Seek urgent medical assessment for:
Repeated vomiting or inability to keep emergency feeds down
Unusual sleepiness, confusion, weakness, or floppiness
Fast, deep, or laboured breathing
Signs of dehydration, such as very little urine
Sudden poor coordination or an abnormal change in behaviour
3
Does any of this apply?
Book an appointment
Routine concerns such as growth, food choices, school planning, medicine side effects, or slowly changing stamina belong in scheduled metabolic follow-up unless there is a sudden decline.
Every sign above is quoted from the sofidex article on Methylmalonic acidemia. If you are not sure, err upward — it is always reasonable to be checked.