In patients with methylmalonyl coenzyme A mutase deficiency, the activity of succinate dehydrogenase decreases, which may affect the tricarboxylic acid cycle of the mitochondria.[10] In this case, the increase in lactic acid during CRRT treatment might be related to the accumulation of excessive citrate in the body. This evidence concerns the gene MMUT and hyperinsulinemic hypoglycemia, familial, 4.