Ketotic Hypoglycaemia in Children: Symptoms, causes, diagnosis and treatment

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Ketotic Hypoglycaemia
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Ketotic Hypoglycaemia

• Ketotic hypoglycaemia is the most common type of
  hypoglycaemia that affects children after the
  neonatal period. However, the condition resolves
  on its own by the time they reach adolescence.
  More commonly, children in the age group of 18
  months to 5 years experience recurrent episodes
  of hypoglycaemia, especially during an illness or
  after fasting for a prolonged time period (more
  than 8 to 16 hours). Hypoglycaemia refers to a
  blood sugar level lower than 70 mg/dL. Usually,
  hypoglycaemia is a complication associated with
  diabetes. So, diabetic children and adolescents
  can experience hypoglycaemia when they take too
  much of insulin or eat too little. But, ketotic
  hypoglycaemia has not been found to be related to
  a specific endocrine or metabolic abnormality. It
  is mainly associated with low tolerance for
  fasting, and most children outgrow this condition
  before they turn 8 to 9 years old. After this
  age, the incidence of this type of hypoglycaemia
  is quite rare.

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What are the causes of ketotic hypoglycaemia?

• Ketotic hypoglycaemia, also known as
  'accelerated starvation', is idiopathic in
  nature. In other words, its causes are not known
  with certainty. Basically, children with this
  condition have a low tolerance for fasting. 
• One possible cause is a defect in
  gluconeogenesis, or generation of glucose from
  non-carbohydrate sources that mainly takes place
  in the liver. Another suspected cause is
  inadequate glycogen stores.
• Ketotic hypoglycaemia is more common in children
  born small for their gestational age, and those
  who have a low body mass index. Therefore, it is
  thought that reduced muscle mass could be the
  reason behind impaired glucose production or
  gluconeogenesis by the liver, that eventually
  leads to hypoglycaemia.

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What are the causes of ketotic hypoglycaemia?

• It has been observed that children born small for
  their gestational age, who develop transient
  neonatal hyperinsulinemic hypoglycaemia, can
  later on develop ketotic hypoglycaemia as well.
  Transient neonatal hyperinsulinemic hypoglycaemia
  is characterised by an excessive production of
  insulin, and so it is suspected that a metabolic
  or endocrine problem may be associated with the
  problem in some patients.
• It has been observed that certain factors can
  trigger an episode of hypoglycaemia. Some such
  important precipitating factors include fasting
  for a prolonged period skipping dinner and eating
  too little, or low carbohydrate intake the
  previous night illnesses like a viral
  infection or stomach flu.

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Symptoms

• Episodes of ketotic hypoglycaemia mostly occur
  in the mornings, usually after a prolonged period
  of fasting. Some of the most common symptoms that
  this condition can produce are 
• Palpitations and anxiety
• Confusion
• Headaches
• Lethargy and malaise
• Unresponsiveness
• A change in behaviour
• Visual disturbances
• Slurred speech and dizziness
• Convulsions and seizures
• Abdominal discomfort
• Nausea and vomiting

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How ketotic hypoglycaemia is diagnosed?

• This condition is diagnosed with the help of a
  number of tests and examinations that help rule
  out the possibility of other conditions that can
  also cause hypoglycaemia with ketosis. Tests are
  carried out for measuring the levels of insulin,
  the growth hormone, cortisol, and lactic
  acid. If the episodes of hypoglycaemia are
  quite frequent, then the patient is closely
  monitored during a diagnostic fast. This test
  helps find out how soon the glucose levels begin
  to fall following fasting, and whether the
  metabolic responses to falling glucose levels are
  normal.

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Treatments

• The best way to prevent ketotic hypoglycaemia is
  to avoid extended fasts and the habit of skipping
  a meal. Children with this condition should be
  fed small, but frequent meals and snacks,
  especially before going to bed. After the usual
  duration of sleep, they should be awakened and
  fed properly.During an episode of
  hypoglycaemia, you should immediately feed the
  child a source of easily-absorbed glucose, such
  as table sugar, candies, or fruit juice. If
  hypoglycaemia causes vomiting, then the child
  should be admitted to the hospital, where the
  condition can be treated with the intravenous
  administration of saline and dextrose. Diet
  should include healthy and nutritious foods.
  Foods with high fibre content, such as fruits,
  vegetables, and whole grains, should be
  incorporated in their diet.

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Treatments
Continue

• Such type of food can ensure the release of
  glucose at a slow and even pace, and thus, help
  maintain the level of blood glucose. If a
  hypoglycaemic child has a low body mass index,
  then along with nutritious foods, the physician
  may prescribe some nutritional supplements as
  well.

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