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September 18, 2003

Diagnosis and Symptoms

Question from North Wales, Pennsylvania, USA:

My daughter had to fast to take medicine for a dental visit and dehydrated very quickly. When they rehydrated her, her ketones were too high to release her and did not come down until after she was allowed to eat. I frequently smell her breath, and when it smells funny I test her urine. When I do this she has ketones in her urine but her sugar levels are fine. What is causing this? She can not drink water. If she has too much water the ketones come back. She has ketones in her urine frequently which go away after she eats. I find that lemonade helps. What is going on?


You don’t say if your daughter has diabetes or not. The presence of ketones merely means that the body is burning fat. Any child, especially a young or small child, will quickly start to burn fat if food is not being supplied.

Sometimes this occurs with hypoglycemia (called ketotic hypoglycemia), and sometimes this can mean insulin deficiency (in those with diabetes associated with high sugars and high ketones). Dehydration is different and reflects how much water (and salt) are being provided or lost. Dehydration can be associated also with metabolic situations where fat is also being burned to supply energy.