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Some of the first symptoms of a metabolic crisis are: poor appetite vomiting extreme sleepiness or lack of energy low muscle tone (floppy muscles and joints) Common blood and urine findings are: ketones in the urine high levels of acidic substances in the blood, called metabolic acidosis high blood ammonia levels high blood and urine levels of glycine high blood and urine levels of methylmalonic acid and propionic acid high levels of other harmful substances low platelets low white blood cells anemia If a metabolic crisis is not treated, a child with MMA can develop: A metabolic crisis can be triggered by: eating large amounts of protein illness or infection going too long without food stressful events such as surgery Between episodes of metabolic crisis, children with MMA may be healthy