A healthy 22-year-old female was diagnosed with anorexia, vomiting, and nausea, as well as a considerable drop in food intake and weight loss of at least 10 kg (15% of her body weight), with no fever. The patient was awake at the time of admission, with a Glasgow Coma Scale of 14 points (E4V4M6), and her physical examination revealed a Kussmaul breathing pattern and a fruity breath odour. The patient's ammonia levels were elevated (261 μmol/L. The cerebral computed tomography (CT) scan was normal.

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