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October 13, 2003

Diagnosis and Symptoms

Question from Gerrards Cross, England (for one year) then Dresher, Pennsylvania, USA:

My six year old adopted son has had acetone breath consistently for several weeks. I’ve tested his urine with the strips for glucose and ketones twice, and they are both negative. He has had this previously only when he was slightly dehydrated from bouts of nausea and vomiting. He is otherwise perfectly healthy and active and has no symptoms of diabetes. We have a dog with diabetes which is why I am familiar with the signs and the breath odor and have the urine strips. Are there other causes of acetone breath in an otherwise normal six year old? In view of the negative strips should I still have his blood glucose tested?


Not everyone can smell acetone, but if you can, the most sensitive vehicle is the breath which may explain why urine testing has been negative. Ketosis in children can occur when the body is unable to get sufficient basal energy needs from the metabolism of carbohydrate and resorts to the breakdown of fat stores with the production of ketones. This can occur because of diabetes, but, as you have noticed, this is most likely to occur when appetite is diminished by intercurrent illness. The same can happen if energy consumption is increased and a child is too busy to eat sufficiently.

I think it very unlikely that what you describe has anything to do with diabetes, but if you have a diabetic dog and the means of measuring blood sugars you might test your son after a period of energetic activity to see if it is low because the phenomenon I have described is called ketotic hypoglycemia.

Additional comments from Dr. Andrea Scaramuzza:

When you have excluded diabetes, as in the case of your son because both urine and blood glucose are in normal range, you can take into account other causes that determine breath acetone-like. In my experience, the most common cause of this in a child of the age of your son is sinusitis. So you can ask your physician for a treatment with aerosol and antibiotics that can normalize the situation.

Additional comments from Dr. Stuart Brink:

You should discuss this with your son’s family doctor or pediatrician. If he really has positive acetone/ketones in either breath, urine or blood then it means that he is burning fat in his body. This would happen with starvation, any kind of illness where glucose cannot be utilized correctly (diabetes with insulin deficiency, for instance) but exactly what is the cause is very complicated and sometimes also associated with hypoglycemia causes.