A five year old girl with type 1 diabetes had repeated large and moderate ketones in her urine for five days with a virus. Because the girl wasn’t vomiting, had no pain, and her blood glucose wasn’t high, the girl’s pediatrician, after a routine exam, recommended continuing at-home care. He remarked that all kids have ketones with a virus, diabetes or not. (The girl’s regular endocrinologist was out of town.)

Some of the parents agreed with the doctor, stating that the child could be kept more comfortable at home. Some of us thought an IV was needed to replenish the girl’s fluids and that five days with repeated large and moderate ketones was risky. Also, do people who do not have diabetes spill glucose and/or ketones in their urine? We have information that they can spill ketones when dehydrated.

Ketones in the urine merely mean that fat is being burned. This can occur if one is obese (overweight) and eating fewer calories or exercise more. It can occur without obesity when one stops eating for any reason — illness, lack of food, increased exercise without sufficient extra calories etc. It also can be a sign of insulin deficiency, or the need for added insulin in a person with diabetes who is ill — virus, bacteria, surgery, severe stress, etc.

So, merely spilling ketones for several days does not tell you much. If you knew the blood glucose levels were not increased in this child with diabetes, then merely providing more energy — carbohydrates or otherwise — is all that is needed. If weight is stable and she is not dehydrated, then there is no reason to provide intravenous fluids or put her in an expensive hospital bed where she is unlikely to get the same care as provided at home by a knowledgeable mom/dad/family.

SB