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The fishy body odor results from excessive production and excretion of trimethylamine, a metabolite of choline

Ceruloplasmin, Coombs test, and G6PD levels were negative

Community starting-dose pattern: A subset of community protocols use 20 mcg for the first 2-3 days to assess hypoglycemia response before stepping up to 50 mcg

After lunch we will start the return trip to Cusco, finishing this beautiful experience

For clinicians, understanding and explaining this phenomenon is essential