I run a small private English preschool, and recently, when a bout of colds and influenza was going around, one of our children was hospitalized because he had been diagnosed previously with acetone hypoglycemia. (This is a literal translation from the Japanese, and I have no idea if that is actually the name of a condition.) The parents had not told us of this condition prior to entering him in our school, and I really have no idea of what it is all about.

I tried to research on the internet, but really didn’t know where to start with all the information passing before me. One article I found talked about the importance of diet, and I have been concerned about the type of things this boy brings for lunch as everything is sweet, for example chocolate cream spread sandwich, etc. The term low blood sugar does suggest not enough sugar, and I beginning to wonder if that’s what the doctors here suggest to the parents. Can you point me in some good directions to find out more about it as I do feel that I need as much information as possible, as I am his care giver during the day.

I am sure that the term ‘acetone hypoglycemia’ is the same as the one used in Europe and North America for ketotic hypoglycemia. It is the most common form of very low blood sugars in small children, and it may occur when there is a loss of appetite for any reason and in consequence blood sugar levels may fall as glycogen stores become depleted. When this happens, fat reserves are used for energy with the consequent production of ketones in blood and urine. The low blood sugars may cause a seizure which is often how the condition comes to attention.

You could find more in any Pediatric text book under Hypoglycemia and also at Parents’ Common Sense Encyclopedia.

DOB
Additional comments from Dr. Stuart Brink:

You should get some specific medical information from the family. I would guess this is ketotic hypoglycemia. Such children are usually well until they get any illness, usually viral respiratory or gastrointestinal infections. Then they do not eat so they cannot maintain normal energy balance and become hypoglycemic during periods of stress, illness and associated lack of food. Sometimes, hypoglycemia also occurs after vigorous exercise. Sometimes hypoglycemia occurs if meals and snacks occur more than three to four hours apart.

There are some odd and rare metabolic syndromes where amino acid imbalance or other intracellular mechanisms are not normal and ketotic hypoglycemia occurs. These can usually be diagnosed by a good general pediatrician but often may require specialized testing by a pediatric endocrinologist or metabolism specialist. Sometimes also done by geneticists.

Treatment usually involves frequent small meals and snacks, sometimes avoiding carbohydrates and simple sugars — often with emphasis on always having protein/fat since the protein and fat contents of food avoids large bursts of sugar and subsequent drops to the hypoglycemic level. When symptomatic, hypoglycemia can be tested with same meters used by people with diabetes — and treatment (rescue) is by simple sugars – Lifesavers, sugar packets or cubes, regular juice, regular sugar containing soda (Coke, 7UP, Pepsi, ginger ale, etc.) or glucose tablets.

SB
Additional comments from Dr. David Schwartz:

I believe that they are referring to a condition that is called “ketotic hypoglycemia.” Generally this occurs in younger (often skinny) children who don’t have a lot of “stored” energy reserves (in the form of readily available fat) in their bodies. Going for prolonged periods of time without eating, or during times of illness, the blood sugar cannot be maintained. In order to keep the body going, metabolism of fat occurs. This leads to the production of “ketones” of which acetone is one, but if the child is thin, the fat reserves don’t last long.

There are some other conditions that are similar but can be more serious and require a special supplement. Regardless, the treatment often is focusing on frequent meals, avoiding prolonged times without eating (like sleeping in on a weekend). Dietary programs often involve less simple sugars (fruit, table sugar, candy, juice) except during illnesses, and the use of morecomplex carbohydrates such as pasta, rice, potatoes, etc.

DS