A 3-month-old baby was brought to the emergency department by his parents who described the child's refusal to feed, lethargy, and rapid breathing rate.A second commercial laboratory confirmed the finding of ethylene glycol.The child was not responding to physical stimulation and was found to have severe acidosis, anion gap elevated at 26.3, and bicarbonate depressed to 3 mmol/L.This encouraged an extensive work-up which revealed that both children suffered from the same inherited metabolic disease, methylmalonic academia (MMA).A test reported acetone at 215 mg/L and ethylene glycol at 180 mg/L.The commercial laboratory reported an ethylene glycol of 911 mg/L at this time.Two months later, the child was brought to the ER by foster parents when he vomited, experienced muscle spasms, and hyperventilated.