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Variation in plasma ketone bodies during a 24-hour fast in normal and in hypoglycemic children: relationship to age
Insights
Fasting blood ketone bodies and glucose levels vary significantly in children. Age influences these levels, which is crucial for diagnosing childhood hypoglycemia and hypoketotic states.
Area of Science:
- Pediatric Endocrinology
- Metabolic Disorders
Background:
- Childhood hypoglycemia necessitates understanding metabolic responses during fasting.
- Blood glucose and ketone body regulation are critical in pediatric metabolic health.
Purpose of the Study:
- To investigate the interplay of blood ketone bodies, blood glucose, and insulin during a 24-hour fast in children.
- To identify age-related variations in these metabolic markers.
- To assess the diagnostic implications for childhood hypoglycemia.
Main Methods:
- Studied 19 normal and 14 hypoglycemic children (4 months to 13 years).
- Monitored blood ketone bodies, blood glucose, and insulin levels over a 24-hour fasting period.
- Analyzed correlations between variables and explored age-specific patterns.
Main Results:
- Significant increase in blood ketone bodies observed in most participants.
- Blood glucose decreased progressively up to 20 hours.
- Strong inverse correlation between blood ketone bodies and blood glucose, with notable dispersion at specific glucose levels.
- Age positively correlated with blood glucose and inversely with blood ketone bodies after 15-21 hours of fasting.
Conclusions:
- Fasting blood ketone body levels are influenced by age, independent of glucose concentration.
- Age-related variations must be considered when interpreting fasting ketone bodies for diagnosing childhood hypoglycemia.
- Findings highlight the importance of age-specific reference ranges in pediatric metabolic assessment.
Abstract:
The variations in blood ketone bodies, blood glucose, and insulin were studied in 19 normal and 14 hypoglycemic children, 4 months to 13 years of age, during a 24-hour fast. Except in four patients (two with hyperinsulinism and two with congenital defect in ketogenesis), a significant increase in blood ketone bodies was observed in both controls and patients. A progressive decrease in glucose concentrations was observed up to but not after 20 hours. A highly negative correlation between blood ketone bodies and blood glucose was found, with a large dispersion of blood ketone bodies, especially for those corresponding to the blood glucose between 45 and 65 mg/dl. This dispersion was consistently reduced in a homogenous age group of 4 to 6 years with similar glucose values. There was a positive correlation between age and blood glucose from hour 21 on, and an inverse relationship between age and blood ketone bodies from hour 15 on. The same high inverse relationship between age and blood ketone bodies was again observed when the variable of glucose concentration was factored out, demonstrating that the variation in blood ketone bodies is indeed related to age. These findings need to be taken into account in the interpretation of fasting blood ketone bodies, especially when used as an aid in the diagnosis of the various forms of childhood hypoglycemia, and of hypoketotic states.