Immunohistochemistry In experiments in which we used anti-Iba1, anti-GFAP, N1D 68 (anti- A), or anti-C3, the signals were visualized with fluorescent secondary antibodies
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GPs can prescribe B12 injections following appropriate investigation, which should include: Full blood count to identify macrocytic anaemia Serum B12 and folate levels to confirm deficiency (using laboratory-specific reference ranges) Methylmalonic acid and/or homocysteine when B12 results are borderline Intrinsic factor antibodies if pernicious anaemia is suspected Additional tests depending on clinical presentation (e.g., thyroid function, coeliac serology) When both B12 and folate deficiency are present, B12 should be replaced before folate to avoid precipitating subacute combined degeneration of the spinal cord
Some patients benefit from antiviral medications that target influenza. CDC recommends antiviral treatment as soon as possible for hospitalized patients
Conclusions A high index of suspicion for hyperammonaemia is mandatory in paediatric patients of any age with suggestive clinical symptoms, given that almost all survivors have developmental disabilities that correlate with the number, severity and duration of hyperammonaemic episodes
