Idiopathic ketotic hypoglycemia in children: an update
Kotb Abbass Metwalley1, Hekma Saad Farghaly1
1Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt.
Insights
Idiopathic ketotic hypoglycemia (IKH) involves low blood sugar and ketones in children, often after fasting or illness. Differentiating between physiological and pathological IKH is key for proper diagnosis and treatment.
Area of Science:
- Pediatrics
- Endocrinology
- Metabolic Disorders
Background:
- Idiopathic ketotic hypoglycemia (IKH) is characterized by episodes of hypoglycemia accompanied by ketosis in children.
- It typically affects young children (10 months to 6 years) and occurs after prolonged fasting or during illness, often in the morning.
- IKH is classified into physiological (common in healthy children with illness) and pathological (associated with hormonal deficiencies, metabolic diseases, or Silver-Russell syndrome).
Purpose of the Study:
- To provide a concise overview of idiopathic ketotic hypoglycemia (IKH).
- To summarize the definition, classification, clinical presentation, diagnostic methods, and treatment strategies for IKH in children.
Main Methods:
- This mini-review synthesizes existing knowledge on IKH.
- It involves reviewing the definition, types, clinical features, diagnostic workup, and management of IKH.
Main Results:
- IKH presents with neuroglycopenia and/or ketosis, often in the morning after overnight fasting.
- Diagnosis requires ruling out other metabolic and hormonal conditions.
- Treatment focuses on adequate carbohydrate and protein intake, avoiding prolonged fasting, and more frequent meals.
Conclusions:
- Understanding the pathogenesis and distinguishing between physiological and pathological IKH is crucial.
- Effective management involves dietary adjustments and frequent feeding to prevent hypoglycemic episodes.
Abstract:
Idiopathic ketotic hypoglycemia (IKH) is defined as bouts of hypoglycemia with increased blood or urine ketones in certain children after prolonged fasting or during illness. IKH is divided into physiological IKH, which is most frequently observed in normal children with intercurrent acute illness, and pathological IKH, which occurs in children who lack counter-regulatory hormones, have a metabolic disease, or have Silver-Russell syndrome. The typical patient is a young child between the ages of 10 months and 6 years. Episodes nearly always occur in the morning after overnight fasting. Symptoms include those of neuroglycopenia, ketosis, or both. IKH may be diagnosed after ruling out various metabolic and hormonal conditions associated with ketotic hypoglycemia. Sufficient amounts of carbohydrates and protein, avoidance of prolonged fasting, and increased frequency of food ingestion are the main modes of treating IKH. It is crucial to understand the pathogenesis of IKH and to distinguish physiological IKH from pathological IKH. In this mini-review, we present a brief summary of IKH in terms of its definition, types, clinical presentation, diagnosis, and therapeutic approach in children.
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