This patient presents with signs and symptoms of acute metabolic decompensation, namely vomiting, diarrhea, lethargy, and seizures. A patient with maple syrup urine disease must be kept out of a catabolic state, especially in times of stress. Stress can lead to acute metabolic decompensation, as evidenced by the patient’s lethargy and seizures. The patient must be immediately started on an intravenous dextrose infusion. An insulin infusion can be started to encourage an anabolic state, if the dextrose alone is ineffective. Intravenous lipids are a good option for long-term nutrition, but not effective acutely. Hypertonic saline is used for cerebral edema related to hyponatremia.