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From Houston, Texas, USA:

Are moderately high ketones ever caused by anything else besides diabetes?

I have IDDM but there's no prior family history. I found out that my 4 year old son had moderately high ketones in his urine the morning after the day I took him to the pediatrician for an asthma problem. I have a good pediatrician and I want to prepare myself for what he might say. My son has been sick for six months with asthma difficulties that get better only on steroids (liquids) but the wheezing and dry coughing comes back when the steroids wear off. He's never been this sickly. He has gained no weight and seems much skinnier to me, but last time I mentioned this to the doctor he said wait until he's well and we'll weigh him again. I'm thinking of asking for a glucose tolerance test. My son is terrified of needles and I don't want to push the unnecessary.


Ketones are produced when the body breaks down too much stored fat to get extra fuel for energy. In fact, in normal metabolic conditions, the main energy source of our human machinery are carbohydrates (i.e., glucose). Quite often very young children with normal (or low) blood sugar are unable to get enough sugar from their stored fat and from stored sugar (glycogen) in the liver while they're are sleeping during the night or are in a "starvation" situation or not taking in normal calories and fluids: then most of the time they can have ketones in their urine in the morning. Stress and illnesses like asthma, flu, and infections, put a stress on the body of a child and this can make his body produce ketones. This usually occurs because in these conditions the body makes hormones like epinephrine and cortisol which cause the body to break down its own fat deposits; this would explain why your son has gained no weight over the last few months while sick.

Ketones can cause nausea, abdominal pain, and vomiting. In these cases, the production of ketones is not related in any way with diabetes.

I would not advise your son to be tested for diabetes by a glucose tolerance test if his blood sugar is normal and the urine is glucose-free.


Original posting 10 Jan 98


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