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23 Statement #1: strong recommendation, low quality evidence (1C) Any individual at any age who presents with any of the following symptoms should undergo prompt plasma ammonia determination: Acute unexplained encephalopathy Acute neurological illness Suspected sepsis in a newborn Developmental delay of unknown cause Recurrent vomiting Acute liver failure, elevated transaminases of unknown cause Ataxia Headache, especially if episodic in women Coma or stupor Psychiatric symptoms Aversion to protein