Ketotic Hypoglycemia in Children

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Ketotic hypoglycemia, also called “toddler’s hypoglycemia,” is a frequent cause of hypoglycemia in young children between the ages of eighteen months and ten-years-old. It tends to affect thin, Caucasian males more than other groups. According to the Mayo Clinic, ketotic hypoglycemia
occurs when children skip meals--usually following an illness. The condition occurs because not enough carbohydrates are stored in the body to make energy; when these stores are low, low blood sugar forces the body to convert fats into carbohydrates to make energy. Ketones are a side effect of this process, hence "ketotic hypoglycemia." The Mayo Clinic states that a build up of ketones in the blood can lead to coma and other serious problems.

Symptoms

  • The first sign of ketotic hypoglycemia may be a severe hypoglycemic episode: a child may appear pale and listless, may faint or even have a seizure. Hussein and Aynsley-Green, researchers at the Great Ormond street Hospital for Children, report that hypoglycemic episodes may be unpredictable, but often occur following an illness. Ketotic hypoglycemia has similar signs and symptoms to many other forms of hypoglycemia. These include: irritability, sweating, nausea, palpitations, fatigue, weakness, lethargy, rapid breathing, dizziness and, in serious cases, loss of consciousness and seizures.

Causes

  • As of 2009, the exact cause of ketotic hypoglycemia remains unknown. According to Huidekoper et. al, ketotic hypoglycemia may not even be a real disease; the assumption is that some children’s bodies may not be able to tolerate fasting as well as others. Other possible causes include hepatic glycogen synthase deficiency, acetoacetyl-CoA thiolase deficiency, and hypoalinemia.

Diagnosis

  • Ketotic hypoglycemia is diagnosed by exclusion; there are currently no tests that can tell if a child has the condition. Instead, your doctor will rule out other diseases like glycogen storage disorders or carnitine metabolism disorders before making a diagnosis. Be prepared to give the doctor as much information as possible about the conditions leading up to your child's attacks. For example, did she have an illness in the weeks prior to the attack? What did she have to eat? What did your child look like? The more information your physician has, the easier it will be to move forward with the correct diagnosis.

Treatment

  • The Mayo Clinic recommends that children with this condition eat frequent meals and snacks. How many snacks and meals your child needs will depend upon how quickly his body uses energy. A home blood sugar monitor will allow you to test your child's blood sugar to determine how long he can go without meals. As a rough guide, a balanced snack (i.e. peanut butter and wholewheat crackers, or hummus and carrots) in between meals should ward off hypoglycemia.

Warnings

  • Hypoglycemia can be a medical emergency. If you suspect that your child is having a hypoglycemic attack, you should see a medical professional immediately. A child who has a hypoglycemic attack may look pale and listless, complain of a stomach ache or say he is not feeling well. In a severe attack, your child may faint and have a Grand mal seizure (in which case, his eyes will roll back in his head and his limbs will stiffen and shake).

References

  • Ann Med, Management of hyperinsulinism in infancy and childhood Hussain K, Aynsley-Green A , 2000
  • European Journal of Pediatrics, Fasting adaptation in idiopathic ketotic hypoglycemia: a mismatch between glucose production and demand, Huidekoper, H, Duran M, Turkenburg, M, Ackermans, M, Sauerwein, H, Wijburg, F, Aug, 2008
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