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Ketotic Hypoglycemia in Children

Ketotic Hypoglycemia in Children

Ketotic hypoglycemia is a condition where the level of blood sugar falls below the normal range following an extended fast. This condition commonly affects children after infancy.
Chandramita Bora
Did You Know?
Fasting tolerance improves with an increase in body mass, which is believed to be the reason why children with ketotic hypoglycemia outgrow this condition by the time they turn 8 to 9 years old.

Ketotic hypoglycemia is the most common type of hypoglycemia 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 hypoglycemia, especially during an illness or after fasting for a prolonged time period (more than 8 to 16 hours).

Hypoglycemia refers to a blood sugar level lower than 70 mg/dL. Usually, hypoglycemia is a complication associated with diabetes. So, diabetic children and adolescents can experience hypoglycemia when they take too much of insulin or eat too little. But, ketotic hypoglycemia 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 hypoglycemia is quite rare.

What is Ketotic Hypoglycemia?
It is characterized by fasting hypoglycemia and ketosis. Ketosis refers to an increase in the level of ketones in the body. When the level of blood glucose is low, the liver releases its stored glycogen, which is converted to glucose in order to maintain adequate serum glucose. This is then followed by lipolysis, where the fat is broken down by the body to derive energy. The process, however, produces ketones as by-products. So, this condition is where the blood glucose level is low, with elevated levels of ketone bodies.

What Causes Ketotic Hypoglycemia?
✦ Ketotic hypoglycemia, 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 hypoglycemia 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 hypoglycemia.

✦ It has been observed that children born small for their gestational age, who develop transient neonatal hyperinsulinemic hypoglycemia, can later on develop ketotic hypoglycemia as well. Transient neonatal hyperinsulinemic hypoglycemia is characterized 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 hypoglycemia. 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

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

Fainting or loss of consciousness, convulsions, and seizures are the signs of severe hypoglycemia, that calls for immediate medical attention.

Diagnosis of Ketotic Hypoglycemia
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 hypoglycemia with ketosis. Tests are carried out for measuring the levels of insulin, the growth hormone, cortisol, and lactic acid.

If the episodes of hypoglycemia 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.

Treating Ketotic Hypoglycemia in Children
The best way to prevent ketotic hypoglycemia 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 hypoglycemia, you should immediately feed the child a source of easily-absorbed glucose, such as table sugar, candies, or fruit juice. If hypoglycemia 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 fiber content, such as fruits, vegetables, and whole grains, should be incorporated in their diet. 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 hypoglycemic child has a low body mass index, then along with nutritious foods, the physician may prescribe some nutritional supplements as well.

Disclaimer: This HealthHearty article is for informative purposes only, and should not be replaced for the advice of a medical professional.