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April 4, 2003

Diagnosis and Symptoms

Question from Nashua, New Hampshire, USA:

When my now 12 year old son was six, he suffered a seizure. I called his doctor who checked him, but didn't run any specific tests at the time. Even after I explained that sometimes this happened for no known cause, the doctor claimed he was a healthy six year old. He had another seizure a year ago (fell at school, and convulsed and passed out), and once again, I brought this to his doctor's attention who ran some blood and urine tests a few days later but was not able to find anything and didn't feel any follow up tests were needed. Two months ago, we moved and needed to get new doctors. This week I received a call from my son's school saying he had a seizure, and they were bringing him to the ER. I explained he had had two other experiences like these in the past so the new doctor ran blood tests and urine tests. He told me he was very dehydrated and asked if he has been eating and drinking enough. I explained he drinks a lot and is constantly hungry. The nurse said he had high urine ketone levels, and it was very concentrated. She claimed his blood sugar level was fine so he didn't have diabetes. The ER doctor said to follow up with his doctor to perhaps arrange to have an EEG performed. He had a CAT scan in the ER which was normal. Should I have his new doctor test him for diabetes? Is the blood test they did in the ER enough?

Answer:

The fact that your son had a normal blood sugar at a time when he was under a lot of stress from a seizure and had ketones in his urine makes it extremely unlikely that his problems are related to diabetes. I would not think that further tests for this are needed. I do however think that he needs to be more fully worked up for the seizures and that this should not only include an EEG but an evaluation for the metabolic disorders that can cause both seizures and ketosis.

DOB
Additional comments from Dr. David Schwartz:

I’d say that depending on the glucose level, if it was not “high” (I’d prefer to know the specific value), then given he likely does not have diabetes. He almost certainly has not had undiagnosed diabetes for six years.

DS
Additional comments from Dr. Tessa Lebinger:

Sounds like your son needs a thorough neurological evaluation. It doesn’t sound likely that your son had high blood sugar, but it is possible he has a metabolic disorder or hormone deficiency making him prone to low blood sugars with ketones (yes, there are times when ketones are made with low blood sugar). A severely low blood sugar can cause a seizure. Blood needs to be drawn at the time of the seizure to see if it is low — before sugar is given in the IV (and if it is low, blood should be sent for cortisol, growth hormone and insulin levels from the same specimen and urine should be tested for ketones). Cortisol and growth hormone deficiency can cause low blood sugars as can insulin excess. Ketones can be seen with growth hormone and cortisol deficiency (and other metabolic problems), but not usually with insulin excess. Your child may also need an endocrine evaluation to sort this out.

TGL