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October 13, 2010


Question from Marlton, New Jersey, USA:

My two-year-old son had six episodes of grand mal seizures in one day in January 2010. During the first seizure, his blood sugar was 40 mg/dl [2.3 mmol/L] and there were ketones present in his urine. In April 2010, he went through the 36 hour fasting test and broke down to sugars lower than 60 mg/dl [3.3 mmol/L] and blood ketones up near 2.0 within 15 hours. Over these past six months, he has been in and out of Children's Hospital more than ten times for treatment of high ketone levels and low blood sugars (although his sugar is never always below 70 mg/dl [3.9 mmol/L] at the moment we take him to the Emergency Room. The treatment at that point is to administer D10 until he starts to eat and drink on his own. He tends to have ketones and low levels only when he has an illness and, as such, the endocrinologist had an immunology work up done on him that proved nothing significantly to explain the frequencies. We were prescribed a meter for home to measure both his ketones and his blood sugars. He never presents with zero ketones and is always at least 0.1 blood ketones or small ketones on the urine test. My son wakes up extremely irritable, fussy and tends to cry a lot every morning. In the morning, his ketone levels tend to be high, somewhere in the 0.3 to 0.6 range and his sugars range from 65 to 90 mg/dl [3.6 to 5.0 mmol/L]. The doctors are still saying this is just ketotic hypoglycemia, but I am having a hard time understanding why he is constantly having ketones. It has changed his appetite and his mood and I am concerned it is affecting other parts of his body including his kidney functions. I am desperately looking for treatment options for him as I don't feel that what we are doing is enough and that there is more going on then what he is being treated for. I am not sure what the next step would be and would love to get input and opinions about the dangers and the possible reasons that my son would be constantly having ketones.


It is impossible to answer your questions without much more laboratory details of his work-up. This is not diabetes. Ketotic hypoglycemia is possible as are other causes of hypoglycemia. You should be able to control this with sufficient overnight food. Have you tried cornstarch supplements or ExtendBar type of bedtime supplements as well as ice cream to see if this hold him sufficiently through the night? If so, not only would he not have hypoglycemia but he would also then clear the ketones. There are also certain glycogen storage disorders which sometimes may also produce some of these same problems. If you are not happy with your current pediatric endocrine team, then there are several others in Philadelphia where you might consider getting a second opinion.