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Ketonuria does not exclude hyperinsulinemic hypoglycemia.

J I Wolfsdorf, A Sadeghi-Nejad, B Senior

    American Journal of Diseases of Children (1960)
    |February 1, 1984
    PubMed
    Summary
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    In normal children, fasting lowers glucose and raises beta-hydroxybutyrate (BOHB) and free fatty acids (FFA). Hypoglycemia in hyperinsulinism shows low BOHB and FFA, but ketonuria can be misleading.

    Area of Science:

    • Pediatric Endocrinology
    • Metabolic Disorders
    • Clinical Chemistry

    Background:

    • Understanding metabolic responses to fasting in children is crucial for diagnosing hypoglycemia.
    • Serum beta-hydroxybutyrate (BOHB) and free fatty acids (FFA) are key indicators of fat metabolism during fasting.

    Observation:

    • In 34 normal children, fasting up to 24 hours showed inverse correlations between glucose and BOHB, and glucose and FFA.
    • Six patients with hyperinsulinism-induced hypoglycemia exhibited relative hypoketonemia (low BOHB) and low FFA levels during hypoglycemic episodes.

    Findings:

    • Hypoglycemia in hyperinsulinism is associated with lower-than-expected BOHB and FFA levels.
    • Despite hypoketonemia, four of six hyperinsulinemic patients showed ketonuria, indicating a potential diagnostic challenge.

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    Implications:

    • Ketonuria in a hypoglycemic child may not rule out hyperinsulinism.
    • Accurate interpretation of BOHB and FFA levels is essential for diagnosing pediatric hypoglycemia.