<prompt> 39 years old, male Chronic knee pain,Headache, nausea, epigastric pain, blurred vision,Progressed over next 48 h to confusion, slowed speech,Progressive decline in GCS, requiring intubation,Seizure activity.CT brain showed cerebral oedema.Ammonia level: 652 mmolL RR, 50 mmolL. profound elevation of urine orotic acid, plasma glutamine level high, arginine level low.What is the pattern of inheritance of the disease?Autosomal dominantAutosomal recessiveX-linked disorderNone of the above  <response>: The above clinical features and laboratory investigations suggests the diagnosis of ornithine transcarbamylase deficiency which is an enzyme required in urea cycle Reference: Harpers illustrated biochemistry 30th edition 