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[Ketoacidosis in a 14 month old child caused by fasting]
A Eichler1, H Förster, K Heller
1Zentrum der Anaesthesiologie und Wiederbelebung, Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt am Main.
Insights
Prolonged preoperative starvation in pediatric surgery can lead to severe ketoacidosis. This case highlights the risks of prolonged fasting in children, even in elective procedures.
Area of Science:
- Pediatric Surgery
- Pediatric Anesthesia
- Pediatric Critical Care Medicine
Background:
- Preoperative starvation is standard for elective pediatric surgery to prevent aspiration.
- Fasting can cause hypoglycemia, thirst, and discomfort in children.
- Metabolic adaptation to fasting involves gluconeogenesis and ketone body production.
Observation:
- A 14-month-old child underwent 36 hours of preoperative starvation.
- The child developed severe intraoperative ketoacidosis.
Findings:
- Fasting in children triggers metabolic shifts to maintain energy supply.
- Accumulation of beta-hydroxybutyrate and acetoacetate can result in ketoacidosis.
- Severe intraoperative ketoacidosis occurred in this case.
Implications:
- Clinicians should be aware of the risk of severe ketoacidosis with prolonged fasting in pediatric patients.
- Careful consideration of fasting duration is crucial in pediatric elective surgery.
- Further research may be needed to optimize fasting guidelines for pediatric surgical patients.
Abstract:
Preoperative starvation in order to prevent pulmonary aspiration is mandatory in elective pediatric surgery. Hypoglycemia, thirst and unwellness have been reported as undesired side effects. The metabolic response towards decreasing blood-glucose concentrations in fasting children includes gluconeogenesis and production of ketone bodies to meet the energetic demand. Accumulation of beta-hydroxybutyrate und acetoacetate in blood can lead to ketoacidosis. We report a case of a severe intraoperative ketoacidosis in a fourteen months old child complicating 36 hours of starvation.