Acetone in children: is it so scary?

What is acetone?

Acetonemic vomiting syndrome (acetone) in children, also known as ketotic hypoglycemia (CH) in childhood, is not a disease, but a metabolic disorder that can begin from 18 months to 5 years, and goes away by itself by 8-9 years of age. It is important to understand that during any illness, stress, or physical activity, the child must be given water, not limit sweets, and be given glucose in solutions and tablets.

With this disorder, the level of ketone bodies (this includes acetone) in the blood, urine and exhaled air increases, and the level of glucose in the blood decreases. The body tries to get rid of excess acetone and removes it through urine and exhaled air. This happens if a child goes hungry for a long time or the body consumes a lot of energy, then blood glucose drops and glycogen reserves are depleted. Since these ketone bodies are an alternative source of energy, when glucose levels are low, they begin to be produced in large quantities, which leads to intoxication of the body, and this, in turn, leads to nausea and vomiting. If normally ketones are detected only in trace amounts, then with this syndrome their amount increases by 50-80 times.

Why do children get acetone?

There is a mechanism for the occurrence of vomiting that is specific to childhood. Let's try to superficially explain its essence. So, the human body receives energy mainly from glucose. Glucose accumulates in the body, primarily in the liver, in the form of a special substance - glycogen. In adults, glycogen reserves are huge, in children they are insignificant. With physical exertion, emotional stress, high body temperature, i.e., with any phenomenon that requires significant energy expenditure from the child’s body, a situation may arise when glycogen reserves run out.

What we have as a result: there is no more glycogen, but energy is still very much needed. As a result, the body begins to receive energy from fat reserves. Intensive breakdown of fat is accompanied by the formation of acetone, which is excreted in the urine (i.e., acetone appears in the urine, which can be determined using special test strips). If there is a deficiency of fluid, acetone accumulates in the blood, irritating the mucous membranes of the gastrointestinal tract and the vomiting center in the brain. Vomiting and abdominal pain occurs. The described situation even received a special name - acetonemic state, and the vomiting that accompanies this condition is called, accordingly, acetonemic vomiting.

Whether a child develops an acetonemic state or not is determined by individual metabolic characteristics: glycogen reserves, the intensity of fat breakdown, and the ability of the kidneys to excrete acetone. Therefore, there are children in whom acetone never accumulates, even at a very high temperature and in a very serious condition, and there are those in whom an acetonemic state occurs in almost any illness - it’s just some kind of punishment.

What is this substance and why does it increase?

Every day a person eats carbohydrates. After entering the stomach, they are digested and glucose enters the blood. Part of it is needed for energy, and the remaining amount is stored as glycogen in the liver. Here, glucose is stored until the body needs additional energy. This can happen during intense physical activity, during illness, or under severe stress. In this case, glycogen enters the blood and is converted into energy.

Most children have sufficient glycogen reserves, so in stressful situations for the body they are not in danger. Sometimes the liver is able to store only a small portion of glycogen. When glucose stores run out, the liver releases fats into the blood. After their breakdown, energy is produced, as well as ketones. If during this period the child does not receive enough fluid, ketone bodies are not excreted from the body and enter the blood. Due to irritation of the stomach walls with acetone, the patient experiences pain, vomiting, nausea and other negative symptoms.

The difficulty in treating this condition is that vomiting occurs in the baby due to a lack of glucose, and it is impossible to obtain glycogen due to vomiting.

Symptoms

How to understand that a child has a tendency to an acetonemic state? After stress, physical and emotional stress, or during illness, the child develops the following signs:

breath smells like acetone or rotten apples
suddenly there was a pain in the stomach
vomit
weakness or even diarrhea
the child constantly wants to sleep

This means the body needs glucose. The main thing is to give glucose and water in time, then vomiting can be avoided.

What to do?

Do not panic! Responsibility for the condition of the child lies only with you!

So, the child is nervous, hungry, and has a smell of acetone on his breath - give him a sweet drink, give him some sweets. Coca-Cola is best, because this drink has a lot of sugar and the child will drink it with great pleasure. This category also includes various sweet lemonades and sodas.

Do not put your child on a diet, especially a hungry one, especially one without sweets. This can make the situation worse. Don't limit your child's sweets! It is necessary to ensure that the distance between meals for the child is at least 4 hours.

It is also important to remember that stress in a state of acetonymia is contraindicated, just like a sharp increase in physical activity. You should always carry 40% glucose and candy with you.

If you doubt that your child has acetone, buy special test strips to determine it in urine. These are paper strips with a reagent that changes color depending on the acetone content in the urine.

If the child’s condition is more severe, then it is necessary to start giving him a sweet drink; in this case, saline solutions will only help against dehydration, but will not affect his well-being. But you can give a saline solution in parallel with sweets.

Sometimes it happens that if there is severe vomiting, it is impossible to give the child a sweet drink. In this case, glucose is administered intravenously or an injection of an antiemetic is given, and while it is working, this is about 2-3 hours, you need to let the child drink as much sweet liquid as possible.

If the condition does not improve, vomiting does not stop, and signs of dehydration appear, call an ambulance, as in this case infusion therapy is needed. As soon as the acetone crisis has passed, you just need to forget about it. Do not torment your child with diets, do not look for reasons, but simply live and do not forbid your child sweets, because in 100% of cases children outgrow this condition.

The main thing is to know how to provide first aid and not to scare the child with hospitalization. Of course, there are situations when a hospital cannot be avoided, for example, when intoxication and dehydration of the body are too severe, then the introduction of glucose through a vein is inevitable, but such conditions are very rare and most often we can cope at home ourselves.

It is worth remembering that this condition can develop in an absolutely healthy child, and acetone syndrome without other signs most often does not mean the presence of diabetes. But if acetone appears in a child often for no reason and is accompanied by sudden weight loss, the child often urinates and is constantly thirsty, then it is worth checking for type 1 diabetes.

Preparing a saline solution for dehydration

A treatment method aimed at introducing fluid into the body is called rehydration therapy. Rehydration is, in fact, the replenishment of fluid losses. There are two main methods of rehydration - intravenous, when the necessary solutions are injected into a vein through a dropper, and oral - when a person receives the necessary solutions through the mouth.

What it is? Sometimes it is a ready-made solution, but usually it is a powder, or tablet, or granules, which contain the sodium, potassium, chlorine and other substances necessary for the body in specially selected combinations and concentrations equivalent to pathological losses. Let me explain: sweating is a loss of not only fluid, but also sodium and chlorine (after all, sweat is salty, and everyone probably remembers the school formula NaCl). If you replenish fluid losses, but do not replenish salt losses, this is fraught with serious problems. How much salt do you still need? So smart scientists calculated the optimal amount of salts for a certain volume of water.

The formulas for rehydrating agents are based on these calculations. In addition to salts, the preparations often contain glucose; sometimes extracts of medicinal plants (chamomile extract, for example), and decoctions of cereals (rice, wheat, etc.) are added.

Oral rehydrating agents are an ideal option for quickly and effectively replenishing physiological and pathological fluid losses.

This is why oral rehydration products are over-the-counter medications.

That is why oral rehydration products should be an essential component of a home first aid kit.

Prevention

To prevent CG, high-carbohydrate (bread, cereals, rice, pasta, corn tortillas) and high-protein foods (red meat, chicken and turkey, fish, beans, eggs, nuts) are recommended. Do not allow your child to take long breaks from eating (maximum 6 hours); It is advisable that the child has at least 5 meals a day. A snack before bed is a must (milk, bun, cereal, bananas)!
In case of an acute infectious disease, fever, nausea, vomiting, or loss of appetite, you should immediately begin giving the child sweet drinks (juices, lemonades, sweet tea, Coca-Cola). It is not necessary and useless to try to feed a child with CG only Borjomi/Narzan/Essentuki/saline solutions: they can prevent dehydration, but without sweet drinks it will not be possible to get the child out of CG, so saline solutions are only an additional measure to sweet drinks.
If you are constantly vomiting and cannot replace fluid loss at home, you should immediately seek help from a doctor. Only if home drinking does not produce an effect, you should drip solutions intravenously - this method of treatment should not be used as a basic one.

What exactly CG is not:

CH is not a disease, but only a violation of the tolerance to prolonged fasting
CG is not a “neuroarthritic diathesis” (there is no such disease). CG is a real problem, “neuro-arthritic diathesis” is a mythical animal, therefore, these two things are not related. What does not exist should not be treated.
CG does not lead to diabetes and is in no way associated with it.
CH is not and never has been a “disorder of purine metabolism.” If someone claims the opposite, he does not understand either the metabolism of purines, or the metabolism of carbohydrates, or metabolism in general. CG is not a disorder of uric acid metabolism and is not associated with gout. A restrictive diet is not indicated, it is dangerous and harmful for CG, and people who recommend that children with CG avoid meat and carbohydrates have absolutely no understanding of this condition.
“Gall bladder bend” is a variant of the normal structure of the gallbladder, and it is very common; this feature is in no way related to CG. By the way, if you have an excess of gallstones, you don’t need a diet either.
KG is not a kidney disease.
CG is not a liver disease.

So, the acetonemic state/ketotic hypoglycemia is not a disease, but a metabolic feature that requires the parent not to torment the child with diets and endless searches for the cause, but attention, so as not to miss and prevent the onset of a crisis. Timely drinking and a “sweet diet” will allow the child to safely outgrow this condition.

Reasons for rejection

Experts say that proper nutrition is the key to human health and well-being. Due to the fact that the digestive system of babies is not yet fully formed, children need to be fed only with the right and healthy foods. In a healthy body, ketone bodies are formed in small quantities. That is, if a child consumes carbohydrates within normal limits, then ketone will be released within acceptable limits.

When there is a nutritional disorder, there is often an imbalance. In addition, doctors identify the following reasons for the appearance of acetone in the blood and urine:

Eating foods that are too high in calories (fatty, fried, sweet). An attack of increased levels of this substance in children can develop after a malnutrition, since the baby’s liver does not process fats well.
Insufficient amount of carbohydrates in the diet. Like their excess, carbohydrate deficiency leads to a deterioration in metabolic processes. Against this background, metabolism is disrupted and fat oxidation and ketone production occur.
Consuming ketogenic amino acids.
Infectious diseases that cause symptoms such as diarrhea and vomiting. Such conditions lead to nutritional starvation, which causes the appearance of acetone in the blood.
Diseases of a congenital or acquired nature associated with a deficiency of enzymes necessary for normal metabolic processes in the body.
Diabetes mellitus of both types and neuro-arthritic diathesis.

Many parents, upon hearing about an increase in ketone bodies in their child’s blood, panic, but this should not be done. Having discovered this condition, it is important to look for its cause. Sometimes a regular diet helps to cope with the problem.