My 35 month old son has had chronic recurring episodes of ketones in his urine for nearly a year. Our pediatrician has tested serum glucose which has been in the low normal range on random testing, and low (40-50 mg/dl [2.2- 2.7 mmol/L]) fasting. Several times, when the ketones have been very high, he has vomited, and he gets very inactive, irritable, and pale during the episodes. He was diagnosed with autism at age 16 months, but has made extremely good progress and now just has slight residual problems. We removed gluten and casein from his diet at age 17 months which this brought about very significant improvement in his autistic traits, but is diet is not deficient in carbohydrates.
Our pediatrician is not concerned about the ketones, and attributes the episodes to the special diet. We have no idea what this could mean. He is a very good eater, and gets a good balance of protein and carbs. He drinks quite a bit of water, but I would only call it excessive on the one to days prior to spilling ketones. We are at a loss!
This story could well be one of ketotic hypoglycemia, with the low fasting blood sugars not really indicating the lowest values. Moreover, this little boy is apparently deprived of cow's milk formula and wheat protein which are two important sources of dietary carbohydrate. I would think it important then to ask the pediatrician why it was considered that this child had both gluten and cow's milk protein sensitivity and how valid both these diagnoses were because both might affect intestinal absorption.
In any case, the rather complex story and presently restricted food intake would justify a full dietary appraisal by a pediatric dietitian to find out exactly what the intake of carbohydrate and other nutrients has averaged. An evaluation of the growth curve since birth would be important. If these steps reveal no further suggestions, it might, in view of some evidence of central nervous system involvement be worth considering one of the rare inborn errors of metabolism that can lead to hypoglycemia.
Additional comments from Dr. Larry Deeb:I would vote for ketotic hypoglycemia, given the information. Not a perfect diagnosis, but likely.
Original posting 14 Dec 2001
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Last Updated: Tuesday April 06, 2010 15:09:30
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