June 24, 2006
Question from Moraga, California, USA:
My daughter was diagnosed with ketotic hypoglycemia at two years, 10 months after a bout of rotavirus. She has consistently been in the 75th percentile for height and 90th percentile for weight, so she does not appear to fit the standard child with ketotic hypoglycemia I have read about. The episode occurred after a trip to a high altitude where she was extremely active (we live at sea level). She started vomiting at 2 a.m. one night during our vacation and could hold nothing down the entire next day, not even a teaspoon of water. We drove home and took her to the Emergency Room (ER) almost 24 hours after the vomiting started. The doctor gave her suppositories to stop the vomiting, but performed no blood work, and we went home. She drank some Pedialyte and juice, about 16 ounces total, through the night and next morning. Around noon, she started vomiting again and could hold nothing down. Mild diarrhea also started. She became more lethargic and that night, around 2 a.m. (48 hours after the vomiting started and 24 hours after the first visit), she started vomiting bile. We took her back to the ER. Her sugar was 26 mg/dl [1.4 mmol/L]. It took a few hours for her sugar to get back over 80 mg/dl [4.4 mmol/L], where they wanted it. She was hospitalized and the doctors performed numerous tests on her, including a fasting blood sugar test, and found nothing out of the ordinary aside from the rotavirus. We saw an endocrinologist who had us test her blood sugar at home for a few weeks. Everything looked okay and we were told she had ketotic hypoglycemia. We just had to be careful to give her something to eat before bed and an early breakfast, which we do. Aside from getting grumpy when hungry, she has been fine since the episode a little over one year ago. I have been told not to worry. However, the episode still haunts me, especially when I talk to many friends whose children had rotavirus for much longer than 48 hours with no signs of hypoglycemia. I also know our doctor will treat the next vomiting episode very seriously. He was worried about the possibility of "genetic conditions," but could not go into specifics. When my other daughter had a vomiting episode a few weeks ago, we watched her blood sugar very carefully and, luckily, she was fine. Is there anything else I can or should do to make sure nothing else is going on? To what type of "genetic conditions" could our doctor have been referring?
While it is worrisome to have a diagnosis of ketotic hypoglycemia, it is actually not so rare. The rotavirus infection is not so critical in this scenario since any viral illness associated with lack of food, vomiting or diarrhea would do the same. Why certain children have ketotic hypoglycemia and others do not is not well understood but, often, kids outgrow such problems as they get older and can better balance of their own metabolism including sugars. I assume that your pediatrician was worried about these types of ongoing metabolic disturbances and other problems of protein and fat balance, but it does not sound likely from your description. So, the only thing that you need to do is to continue to make sure that there is sufficient food energy supplies especially during such illnesses plus check blood glucose levels periodically to see if this persists or not.