February 7, 2003
Question from Maple Valley, Washington, USA:
My five year old son has ketotic hypoglycemia, and while he is not having episodes as often as he used to, he still has problems with low blood sugar and running large and extra large ketones when he gets sick. The last time he had the stomach flu he ran extra large and large ketones for several days. While he was no longer throwing up from the flu, he then began throwing up again, and I do believe it was from the ketones. Similarly, this week he has been very sick with an upper respiratory virus, having low blood sugars and running large ketones for two days, and tonight he has been throwing up. I've managed to get some food and liquid back in him, and the ketones are finally coming down. Can a child with ketotic hypoglycemia get sick from ketones? At what point do I need to get him into the doctor? Can there be possible damage to his liver?
I agree that for most intents and purposes, “ketones are ketones” but the degree of ketone accumulation in someone with type 1 diabetes is far different than in the situation that you describe in your child. The child with ketotic hypoglycemia can have fairly rapid metabolism of the ketones when the glucose goes up and they produce insulin. (Insulin is the key — the individual with ketosis due to type 1 diabetes is lacking insulin.)
So, it sounds as if you are doing the correct things. For the child with ketotic hypoglycemia, there is probably greater issue with low blood glucose than with mild elevations in ketones. If the child is so lethargic or “out of it” or so ill with vomiting that sugary liquids cannot be kept down, then rather expedited medical attention is warranted.
Certainly with illnesses, you want to start monitoring the urine (or blood with special meters) for ketones and start to encourage sugary foods and drinks.