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Until proven otherwise, with such a raised AFP and "normal liver" need to exclude a germ cell tumour (check stomach, and mediatinum)(can get mild raises in heptatitis, but resolve) His clinical presentation sounds like a typical IEM until proven otherwise. The normal amino and organic acids were checked when the baby was acutely sick I hope? Have plasma/urine acylcarnitines been checked if acute specimens missed Presume ammonia raised in acute presentation? ------ACB discussion List Information-------- This is an open discussion list for the academic and clinical community working in clinical biochemistry. Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content. ACB Web Site http://www.acb.org.uk List Archives http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions (How to leave etc.) http://www.jiscmail.ac.uk/