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Ketotic Hypoglycaemia

Introduction of 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
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 hypoglycaemiahas not been found to be
related to a specific endocrine ormetabolic 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.

Casue 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
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 aviral infectionorstomach flu.

Symptom of Ketotic Hypoglycaemia

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
Lethargy and malaise
A change in behaviour
Visual disturbances
Slurred speechand dizziness
Convulsions and seizures
Abdominal discomfort
Nausea and vomiting

Diagnosis of Ketotic Hypoglycaemia

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

Treatment of Ketotic Hypoglycaemia

The best way toprevent ketotic hypoglycaemiais 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 anddextrose.
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. Such type of
food can ensure the release of glucose at a slow and even pace, and thus, help
maintain the level ofblood glucose. If a hypoglycaemic child has a low body mass
index, then along with nutritious foods, the physician may prescribe somenutritional
supplementsas well.