Which inborn error of metabolism would you suspect in a child with intermittent hypoketotic hypoglycemia, especially during fasting or illness?
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Correct answer: Medium-chain acyl-CoA dehydrogenase (MCAD) deficiency
MCAD deficiency impairs fatty acid β-oxidation; during fasting, the inability to oxidize fatty acids prevents ketone production, causing hypoketotic hypoglycemia, often with lethargy or seizures.
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