Acetone in a newborn is the result of dangerous diseases

What to do if a child develops acetonemic syndrome? Causes and treatment recommendations

Acetonemic syndrome is expressed by symptoms that are caused by a metabolic failure. An unpleasant condition occurs when ketone bodies accumulate in the blood. Acetone crises can often occur: dehydration, repeated vomiting, the smell of acetone from the mouth, low-grade fever, abdominal syndrome.

The disease is diagnosed on the basis of certain symptoms, as well as tests - ketonuria, elevated urea levels, and electrolyte imbalance are determined. In the case of an acetonemic crisis, it is important for the child to undergo infusion therapy, give a cleansing enema, and put him on a diet containing easily digestible carbohydrates as early as possible.

What it is?

Acetonemic syndrome is a condition that occurs when metabolic processes in a child’s body are disrupted, a kind of failure in metabolic processes. At the same time, no malformations of the organs, no violations in their very structure are detected, it’s just that the functioning of, for example, the pancreas and liver is not regulated.

This syndrome itself is one of the manifestations of the so-called neuro-arthritic anomaly of the constitution (neuro-arthritic diathesis is the old name for the same condition). This is a certain set of character traits combined with a certain functioning of the child’s internal organs and nervous system.

Rules for feeding children with acetone

Increased acetone can be caused by a lack of carbohydrates in the diet, abuse of fatty and protein foods, a strict diet or prolonged fasting. As Dr. M. P. Kalapos notes, impaired carbohydrate metabolism and lack of fluid in the body lead to disruption of the brain and depletion of the reserves of the pancreas and liver.

Why do you need a diet with high acetone? A certain diet is necessary to alleviate the child’s condition, relieve intoxication and restore balance in the body. Medicines can be used in a critical situation, but recovery requires a proper diet.

Causes

Acetone syndrome occurs more often in children, but also occurs in adults. Its reasons include:

• kidney disease - in particular renal failure;
• deficiency of digestive enzymes - hereditary or acquired;
• congenital or acquired disorders of the endocrine system;
• diathesis – neurogenic and arthritic;
• dyskinesia of the bile ducts.

In infants, a similar condition may be a consequence of late gestosis in pregnancy or nephropathy.

External factors causing acetone syndrome:

• fasting, especially long-term;
• infections;
• toxic effects - including intoxication during illness;
• digestive disorders caused by malnutrition;
• nephropathy.

In adults, the most common cause of accumulation of ketone bodies is diabetes mellitus. Lack of insulin blocks the entry of glucose into the cells of organic systems, which accumulates in the body.

Symptoms

Acetonemic syndrome often occurs in children with constitutional abnormalities (neuroarthritic diathesis). Such children are distinguished by increased excitability and rapid exhaustion of the nervous system; they have a thin physique, are often excessively fearful, suffer from neuroses and restless sleep.

At the same time, a child with a neuro-arthritic constitutional anomaly develops speech, memory and other cognitive processes faster than his peers. Children with neuro-arthritic diathesis are prone to impaired metabolism of purines and uric acid, therefore in adulthood they are susceptible to the development of urolithiasis, gout, arthritis, glomerulonephritis, obesity, and type 2 diabetes mellitus.

Symptoms of acetone syndrome:

1. The child's breath smells of acetone. The same smell comes from the baby's skin and from his urine.
2. Dehydration and intoxication, pale skin, the appearance of an unhealthy blush.
3. The presence of vomiting, which can occur more than 3-4 times, especially when trying to drink or eat something. Vomiting may appear in the first 1-5 days.
4. Worsening of heart sounds, arrhythmia and tachycardia.
5. Lack of appetite.
6. Increased body temperature (usually up to 37.50C-38.50C).
7. As soon as the crisis begins, the child shows anxiety and agitation, after which he becomes lethargic, drowsy and weak. Extremely rare, but seizures may occur.
8. There are cramping pains in the abdomen, stool retention, nausea (spasmodic abdominal syndrome).

Often, the symptoms of acetonemic syndrome occur due to malnutrition - a small amount of carbohydrates in the diet and a predominance of ketogenic and fatty amino acids in it. Children have an accelerated metabolism, and the digestive system is not yet sufficiently adapted, as a result of which ketolysis decreases - the process of utilization of ketone bodies slows down.

Acetone syndrome in children

When a large number of ketone bodies (acetone and acetoacetic acid) accumulate in the child’s blood, the child develops an acetonemic crisis.

Recurrence of crises indicates the presence of acetonemic syndrome in the child.

Acetonemic syndrome is not a disease, but an extreme manifestation of the characteristics of a child’s body, which occurs as an inadequate reaction to ordinary external stimuli. There are primary and secondary acetonemic syndrome.

Secondary syndrome accompanies a number of diseases: diabetes mellitus, infectious toxicosis, traumatic brain injury, brain tumors and others.

Primary acetonemic syndrome

Develops in children from the first year of life and can be accompanied until 10-12 years of age.

As a rule, such children experience neuro-arthritic diathesis (NAD).

NAD is based on a violation of purine metabolism as a result of liver enzyme deficiency. Excess uric acid increases the excitability of the nervous system. Children with NAD immediately after birth are characterized by sleep disturbances, excitability, fearfulness, and do not gain enough weight. Neuropsychic development, on the contrary, is ahead of age norms: children begin to talk early, are inquisitive, remember and retell stories well. From 2-3 years of age, they experience night pain in the joints, abdominal pain, biliary dyskinesia, odor intolerance, low temperature, enuresis, skin allergies, and the appearance of urate salts in the urine. Older children develop neuroses, asthenia, and vegetative-vascular dysfunction.

The most pronounced manifestation of metabolic disorders in children with NAD is an acetonemic crisis.

Many factors can contribute to its development: fear, pain, conflict, excess emotions, overheating, physical stress, nutritional errors (excess proteins and fats).

The crisis occurs suddenly or after warning signs: headache, nausea, abdominal pain, lethargy or agitation, poor appetite, smell of acetone from the mouth.

Manifestations of acetone crisis

– repeated or uncontrollable vomiting for 1-5 days;

– dehydration and intoxication;

– anxiety and excitement at the beginning of the crisis are replaced by lethargy and drowsiness;

– cramping abdominal pain, nausea;

– increase in body temperature to 37.5-38.5;

– presence of acetone in urine, vomit, and exhaled air.

Actions of parents during an acetonemic crisis

At the first bouts of vomiting, the child is shown to be hungry. Do not give large amounts of water, as this will cause more rounds of vomiting. It is necessary to do a cleansing enema with cool water at 25-26 degrees. Start feeding your child sweet tea with lemon, alkaline non-carbonated mineral waters such as Borjomi, Polyana Kvasova, complex solutions such as Rehydron, Humana Electrolyte, fructose solution (absorbed faster than glucose), and a decoction of dried fruits. Drink in small doses: 1 teaspoon every 5 minutes, alternating types of drinks. The child should drink a volume of liquid of at least 100 ml/kg of body weight per day. In addition to drinking, you can make microenemas with a warm 35-36 degrees soda solution (1 teaspoon of soda per 200 ml of water).

Monitor the level of acetone in urine using an acid test.

If it is impossible to give the child something to drink or his condition worsens, he must be hospitalized for infusion therapy.

Diet of the first days of crisis

Day one: drink only. Once the vomiting stops, you can give a cracker.

Day two: drink, crackers, rice water (to loosen stool), baked apple.

Day three: drink, crackers, liquid pureed porridge, baked apple.

Day four: drink, biscuits, porridge with water, vegetable soup.

Further expansion of the diet includes pureed water, porridge - buckwheat, oatmeal, rice, sea fish, soup with beef meatballs, turkey, omelet, kefir, steamed dishes.

Drug therapy is determined by the doctor.

Prevention of acetone syndrome

Children with acetone syndrome should not be overfed or force-fed. Meals should be frequent, 5-6 times a day. The basic principle is a hypoketogenic diet, i.e. exclusion (limitation) of foods containing purines, reducing the fat content of the diet.

From the diet, exclude soups with meat broth, veal, young poultry, offal, smoked meat, marinades, soups with fish broth, river fish (except pike perch and pike), tomatoes, champignons, baked goods, chips, chocolate, sour fruits (cherries, oranges), yogurt, full-fat cottage cheese and cheese, black tea, coffee, carbonated drinks, concentrated juices.

Often drink dried fruit compote, green tea with lemon.

For any illness, stress, stress, give glucose tablets - "ASKANOVA" from 4 years of age 4-6 tablets per day, at 7-10 years old - 6-8 tablets, from 10 years old - 10 tablets per day.

Due to the restriction of the diet in the winter-spring period, conduct courses of vitamin therapy and medicinal prophylaxis 2 times a year.

Walking often, dosing physical activity, a swimming pool is useful.

Although acetonemic crises in most children stop after 10-12 years, there remains a high probability of developing hypertension, urolithiasis, diabetes mellitus, and gout in adulthood.

In this regard, children with NAD are considered a risk group and are subject to dispensary observation.

Pediatrician of the highest category V.I. Cooper.

Diagnosis of the syndrome

Parents themselves can carry out express diagnostics to determine acetone in urine - special diagnostic strips that are sold in pharmacies can help with this. They need to be lowered into a portion of urine and, using a special scale, determine the level of acetone.

In the laboratory, in a clinical urine test, the presence of ketones is determined from “one plus” (+) to “four pluses” (++++). Mild attacks - the ketone level is + or ++, then the child can be treated at home. “Three pluses” correspond to an increase in the level of ketone bodies in the blood by 400 times, and four – by 600 times. In these cases, hospitalization is required - such an amount of acetone is dangerous for the development of coma and brain damage. The doctor must certainly determine the nature of the acetone syndrome: whether it is primary or secondary - it developed, for example, as a complication of diabetes.

At an international pediatric consensus in 1994, doctors defined special criteria for making such a diagnosis; they are divided into basic and additional.

Mandatory criteria:

• vomiting recurs sporadically, in bouts of varying intensity,
• between attacks there are intervals of the baby’s normal state,
• the duration of crises ranges from several hours to 2-5 days,
• negative laboratory, radiological and endoscopic examination results confirming the cause of vomiting as a manifestation of the pathology of the gastrointestinal tract.

Additional criteria include:

• episodes of vomiting are characteristic and stereotypical, subsequent episodes are similar to previous ones in time, intensity and duration, and the attacks themselves may end spontaneously.
• attacks of vomiting are accompanied by nausea, abdominal pain, headaches and weakness, photophobia and lethargy of the child.

The diagnosis is also made by excluding diabetic ketoacidosis (complications of diabetes), acute surgical pathology of the gastrointestinal tract - peritonitis, appendicitis. Neurosurgical pathology (meningitis, encephalitis, cerebral edema), infectious pathology and poisoning are also excluded.

Diagnosis of acetone syndrome

Diagnosis of this disease is based on anamnestic data, the results of a physical examination of the child by a doctor, as well as data from additional diagnostic methods (laboratory and instrumental).

When talking with parents and the child, the doctor clarifies whether the patient has previously had acetonemic crises and finds out what could have caused the development of this condition now. After this, the doctor conducts a thorough examination of the patient.

Of the laboratory methods for diagnosing this disease, the following must be used:

1. General clinical tests . When performing a general blood test, an increase in leukocytes and an increase in the erythrocyte sedimentation rate (ESR) may be observed. A general urine test reveals ketones (ketonuria). Determination of ketones is also possible using special test strips, which, when lowered into urine, change their color for a while (if they contain ketones). The color of the test strip is then compared with the samples on the package and the level of ketonuria is determined.
2. Biochemical blood test , which necessarily determines the level of blood glucose, electrolytes, total protein, urea, liver tests, etc.
3. Coprogram.
4. Analysis of feces for helminth eggs.

Of the instrumental methods, ultrasound of the abdominal organs and kidneys is mandatory. Other instrumental studies are carried out if indicated.

Considering that this syndrome can occur due to many diseases, to diagnose the underlying pathological process, they consult specialists (endocrinologist, gastroenterologist, etc.).

How to treat acetone syndrome

If an acetonemic crisis develops, the child must be hospitalized. Dietary correction is carried out: it is recommended to consume easily digestible carbohydrates, strictly limit fatty foods, and provide frequent drinking in large quantities. A good effect is obtained from a cleansing enema with sodium bicarbonate, a solution of which can neutralize some of the ketone bodies that enter the intestines. Oral rehydration using combined solutions (Orsol, Rehydron, etc.), as well as alkaline mineral water, is indicated.

The main directions of treatment of non-diabetic ketoacidosis in children:

1) A diet (enriched in fluids and readily available carbohydrates with limited fat) is prescribed to all patients.

2) The administration of prokinetics (motilium, metoclopramide), enzymes and cofactors of carbohydrate metabolism (thiamine, cocarboxylase, pyridoxine) promotes an earlier restoration of food tolerance and normalization of fat and carbohydrate metabolism.

3) Infusion therapy:

• quickly eliminates dehydration (deficiency of extracellular fluid), improves perfusion and microcirculation;
• contains alkalizing agents, accelerates the restoration of plasma bicarbonate levels (normalizes acid-base balance);
• contains a sufficient amount of easily accessible carbohydrates, which are metabolized in various ways, including those independent of insulin;

4) Etiotropic therapy (antibiotics and antiviral drugs) is prescribed according to indications.

In cases of moderate ketosis (acetonuria up to ++), not accompanied by significant dehydration, water-electrolyte disturbances and uncontrollable vomiting, diet therapy and oral rehydration are indicated in combination with the prescription of prokinetics in age-related doses and etiotropic therapy of the underlying disease.

When treating acetone syndrome, the main methods are those aimed at combating crises. Supportive treatment is very important to help reduce exacerbations.

Symptoms of acetone syndrome

Acetone syndrome begins acutely, but some children may experience weakness, headache, and nausea before developing clinical symptoms. The main symptoms that are detected in children with acetone syndrome are the following:

1. Repeated vomiting is one of the most characteristic signs of acetone syndrome, and the vomit may be mixed with bile. It becomes impossible to give water or food to the child, since every such attempt causes vomiting. Against this background, children quickly develop dehydration.
2. Dry skin.
3. Severe symptoms of intoxication, which manifest themselves:
   pale skin with blush on the cheeks;
4. increased body temperature;
5. lethargy, apathy;
6. drowsiness.
7. Manifestations from the central nervous system:
   excitement at the initial stages of development of the syndrome, which then gives way to weakness;
8. drowsiness;
9. convulsions in severe cases;
10. the development of acetonemic coma may occur in the absence of adequate therapy.
11. The appearance of a characteristic odor of acetone in the air exhaled by the child.
12. Abdominal pain of a cramping nature.
13. Abnormal stool (diarrhea or constipation).

It is worth noting that this syndrome, in addition to the fact that it itself is capable of causing severe dehydration in a child, can also accompany and be the first manifestation of a fairly large number of pathological conditions, including life-threatening ones. Therefore, if a child has the listed symptoms, it is extremely important to seek help from a doctor as soon as possible to determine the cause of this condition and conduct adequate treatment for acetone syndrome.

Infusion therapy

Indications for prescribing infusion therapy:

1. Persistent repeated vomiting that does not stop after the use of prokinetics;
2. The presence of hemodynamic and microcirculation disorders;
3. Signs of impaired consciousness (stupor, coma);
4. The presence of moderate (up to 10% of body weight) and severe (up to 15% of body weight) dehydration;
5. The presence of decompensated metabolic ketoacidosis with an increased anion gap;
6. The presence of anatomical and functional difficulties for oral rehydration (anomalies of the facial skeleton and oral cavity), neurological disorders (bulbar and pseudobulbar).

Before starting infusion therapy, it is necessary to ensure reliable venous access (preferably peripheral), determine hemodynamics, acid-base and water-electrolyte balance.

Dietary recommendations

Products that are strictly excluded from the diet of children suffering from acetone syndrome:

• kiwi;
• caviar;
• sour cream - any;
• sorrel and spinach;
• young veal;
• offal - lard, kidneys, brains, lungs, liver;
• meat - duck, pork, lamb;
• rich broths - meat and mushroom;
• vegetables - green beans, green peas, broccoli, cauliflower, dry legumes;
• smoked dishes and sausages
• You will have to give up cocoa and chocolate in bars and drinks.

The diet menu must include: rice porridge, vegetable soups, mashed potatoes. If symptoms have not returned within a week, you can gradually add dietary meat (not fried), crackers, herbs and vegetables.

The diet can always be adjusted if signs of the syndrome return again. If you have bad breath, you need to add a lot of water, which you need to drink in small portions.

1. On the first day of the diet, you should not give your child anything other than rye bread crackers.
2. On the second day, you can add rice water or dietary baked apples.
3. If you do everything correctly, then by the third day the nausea and diarrhea will go away.

Under no circumstances should you stop the diet if your symptoms go away. Doctors recommend strictly adhering to all its rules. On the seventh day, you can add biscuits, rice porridge (without oil), and vegetable soup to your diet. If the body temperature does not rise and the smell of acetone has disappeared, then the baby’s diet can be made more varied. You can add lean fish, vegetable puree, buckwheat, and fermented milk products.

Prevention measures

Parents whose child is prone to this disease should have glucose and fructose preparations in their home medicine cabinet. Also, you should always have dried apricots, raisins, and dried fruits on hand. The baby's meals should be fractional (5 times a day) and balanced. As soon as any sign of an increase in acetone appears, you should immediately give the child something sweet.

Children should not be allowed to overexert themselves, either psychologically or physically. Daily walks in nature, water procedures, normal eight-hour sleep, and hardening procedures are shown.

Between attacks, it is good to carry out preventive treatment of crises. This is best done in the off-season twice a year.