Question from Bath, Maine, USA:

Is there cause for concern when a 5 year old non-diabetic has ketones in her urine several times over the course of six weeks? In particular, I first took my daughter to the doctor in March due to increased tiredness and thirst, both of which were noticed at home and at school (we received a call from the teacher). When I had trouble waking her up one morning, I took her in and they tested her urine. They found small ketones and requested more urine to send to the laboratory for further testing. That sample showed large ketones, so they drew blood. The blood work showed ketones, but normal blood sugar. So, they told us she didn’t have diabetes but that we “must have her on a low carbohydrate diet.” This child LOVES her carbs! Before that test she had a pop-tart, strawberries and milk for breakfast.

Since then, we’ve tested at home once a week, with four out of the six times showing some ketones. A nurse friend had suggested buying our own test strips at the drug store. The symptoms, which include falling asleep during the day, even after 11 hours of sleep at night, getting up for water several times during the night, low energy, and irritability, don’t occur every day, but there seems to be a pattern related to when she last ate (i.e., seems to be worse right after school when she hasn’t eaten since lunch and early in the morning).

This is a new pediatrician for us because the previous one, whom we loved, left to go oversees in March. We were not happy with her response in this situation and will most likely be looking for a new doctor. In the meantime, is there any cause for concern? This child has had many medical issues over her short life and I don’t want to submit her to unnecessary tests.

One year ago, she vomited every night for four weeks and was subjected to a battery of tests and put on medication for six weeks to treat a high level of inflammation in her body (SED rate as high as 101). The root cause was never determined. Two years ago, she had eight seizures over the course of three days, after a bout with the stomach flu. We were told that was due to dehydration and electrolyte imbalance.