Generality
Acetone in children is a transient metabolism disorder. This condition occurs quite frequently during childhood, when the body lacks sugars (ie the first source from which the body draws energy).
Acetone in children can be the consequence of inappetence or prolonged fasting due, for example, to high fever or intestinal disorders .
Since glucose (ie sugar) is no longer available to extract the energy needed for its functioning, the body is forced to burn fat as an alternative fuel. During this reaction, there is the production, at the liver level, of some waste substances: the ketone bodies ( acetone, acetoacetic acid and beta-hydroxybutyric acid ).
In general, acetone in children is a passing disorder, which resolves quickly, without causing too much trouble. Symptoms include: vomiting, pain in the belly, headache, exhaustion, pallor and breath that takes on a characteristic smell of ripe fruit.
Acetone therapy in children is primarily dietetic; this involves eliminating excess fat and resorting to simple carbohydrates, to be administered frequently, in small quantities. In this regard, especially sugary drinks, such as juices and fruit juices, are recommended so that the body can resume using glucose as a fuel.
To remember
Sugars taken with food, when they exceed the amount needed for basal metabolism, are accumulated in the form of fat. The inverse process, that is the transformation of fats into glucose, occurs when the energy demand increases and determines the production of ketone bodies by the liver.
What's this
Acetone (also called ketosis or acetonemia ) is a disorder of temporary metabolism, frequent especially in children. This occurs when the body, in the absence or lack of glucose ( sugar ), begins to burn fat to meet its energy needs.
The liver thus produces three acids, called ketones or ketone bodies :
- Acetone (chemical compound from which the disorder takes its name);
- Acetoacetic acid ;
- Beta-hydroxybutyric acid .
These substances are normally produced by the body, but when the ketone bodies (in particular the acetone) are produced in excessive quantities, a state of acidosis may occur.
Why is it called "acetone"?
Acetone is a disorder so called because, when it occurs, the baby's breath has a strong smell, similar to that of the solvent used to remove nail polish or that of fermented or overripe fruit.
Causes
Acetone is a frequent condition especially in children, but not only. The disorder can occur due to certain conditions, such as prolonged fasting or a febrile episode, which involve a considerable expenditure of energy and cause the body to increase the demand for glucose.
At the origin of acetone in children
When the metabolism exhausts all available sugar reserves, to cope with the increase in basal metabolism, the body draws energy mainly through the catabolism of fats . During this process substances called ketone bodies are formed, which end up in both the airways and urine, giving off their unmistakable acetone odor, similar to that of ripe fruit.
The production of ketone bodies increases ( hyperketonemia ) up to reaching levels that are toxic to the body, responsible for acidosis.
In an attempt to reduce their concentration, the ketone bodies are eliminated with urine (acetoacetic and beta-hydroxybutyric acids) and with breathing through the lungs (acetone). The latter, in contact with air, is responsible for the smell of ripe fruit .
Acetone: why is it common in children?
Acetone is a common disorder especially in children, since the organs in which the sugars, ie the liver and muscles, are stored have limited storage capacity compared to those of adults. For this reason, a febrile episode or a gastroenteritis (in common jargon, a gastrointestinal influence) is sufficient, so that the body makes use of all its energies and runs out of glucose supplies.
Who is at most risk?
Acetone affects mainly children aged between 2 and 6 years, progressively reducing up to 12 years and with puberty. There is a certain predisposition to acetonemia, related to age and constitution, so some children are more prone to acetone than others.
Acetone in children occurs more frequently under the following conditions:
- Prolonged fasting ;
- High fever ;
- Very unregulated food, too rich in fats (dairy products, fatty meats, fried foods, chocolate) and poor in complex carbohydrates, such as pasta and bread (especially wholegrain);
- Intense and prolonged efforts ;
- Salicylate poisoning ;
- Childhood diabetes or congenital metabolic dysfunction.
Symptoms and Complications
The ketone bodies produced during acetone in children can reach more or less toxic levels.
In an attempt to reduce its plasma concentration, the body tries to eliminate them with urine and through breathing. The first alarm bell of acetone in children is represented, in fact, by the breath that takes on a particular smell of ripe fruit . Then, the body reacts with repeated attacks of vomiting, abdominal pain, headache, pallor and dehydration.
Acetone in children: how to recognize it
Acetone in children is recognized by the appearance of the characteristic symptoms of ketoacidosis, which include:
- Fruity breath (also called " acetonemic breath "; often, it is the first and only symptom);
- Vomiting that repeats itself at entrances, first food, then watery and bile, which, depending on the intensity and frequency, can lead to a state of dehydration and cause a sense of general malaise with the appearance of:
- Headache;
- Abdominal pains;
- Dry and patinated tongue;
- Obvious dark circles;
- Deep and frequent breath;
- Fatigue and poor vitality.
- Diarrhea ;
- Inappetence (or intolerance to the introduction of food);
- Alteration of consciousness (rarely).
Cyclic vomiting syndrome
Some children experience acetone crisis with a certain regularity, approximately every 20-30 days. Typical manifestations are frequent, prolonged and self-limiting attacks of vomiting associated with headache, pallor, prostration and lethargy. In this case, we speak of " recurrent acetonemic vomiting " or " cyclic vomiting syndrome ".
This condition occurs without any apparent cause, but appears to be related to migraine : children suffering from these forms of acetone tend to develop this form of headache either as a child or as an adult.
Healing times
An episode of acetone in children lasts from 24 to 48 hours and ends spontaneously with normal restoration of gastric function. Usually, the situation is resolved without further complications, but care must be taken because, if liquids are not tolerated by mouth, it may be necessary to rehydrate intravenously .
In general, the situation is resolved fairly quickly, but during the acetone crisis in children and in the next couple of days it is good to pay attention to the diet.
Diagnosis
The diagnosis of acetone in children is very simple and is formulated by the pediatrician on the basis of the symptoms and anamnesis. The smell of breath already offers a good clue; for confirmation, a urine test is sufficient to highlight the presence of ketone bodies.
If acetone is suspected in children, parents can perform an easy test even at home, using test strips (or urinary sticks) for the search for ketonuria . These devices are bought in pharmacies and should be used by dropping a few drops of urine on them. Depending on the intensity of the acetone in children, the test strips change color: from white to purple, more or less dark. In this case, the pediatrician will indicate the diet or therapeutic regimen to be followed.
When to consult a doctor
- If the acetone becomes frequent or persists for more than 2-3 days, especially if accompanied by vomiting, stomach ache or fever, it is good to have the pediatrician visit the child. The doctor can prescribe an analysis of urine and blood to check for the presence of ketone bodies.
- Since acetone in children can give rise to severe dehydration and electrolyte imbalance, hospitalization is sometimes necessary. Better talk about it with the pediatrician or go to the emergency room, as intravenous rehydration may be required.
Treatment and Remedies
In general, acetone in children is a passing disorder, which resolves quickly, without the need for specific drugs. Healing can be promoted by adopting a fat-free diet and replenishing the fluids lost with vomiting.
To reduce the formation of acetone in children and facilitate their resolution, traditional treatments include the intake of juices, sweetened drinks and fruit juices, so that the body can resume using sugars as an energy fuel. Centrifuges or home-made extracts are also excellent. Another important thing is to drink water, in small sips and repeatedly, to rehydrate the baby.
If the acetone crisis in children is more intense, simple carbohydrates are useful, to be administered in small quantities in case of vomiting: for example, it is recommended to try to periodically give a teaspoon of sugar water .
If acetone in children does not resolve through the administration of fluids by mouth, it will be necessary to use an infusion of glucoelectrolytic solutions by parenteral route .
In general, acetone in children resolves fairly quickly, but during the crisis and in the next couple of days, more attention is needed to the diet, which must be rich in carbohydrates and low in fat . In other words, the diet should be light and nutritious : therefore, foods such as whole cow's milk, cheese, ice cream, butter, chocolate, packaged snacks, sausages, fatty red meats, fries and pizza should be avoided. During the healing of acetone in children, however, foods such as pasta, bread, biscuits, jam, rice, fruit and vegetables, fish and white meat (chicken, veal, rabbit, turkey: steamed or grilled) are permitted. .
Some advice
To prevent the appearance of further crises, acetone in children is prevented by establishing a balanced diet, which reduces or strongly limits fats (especially whole milk, butter, cheese, fried foods, fatty meats, chocolate and sausages). Between episodes, it is better to prefer complex carbohydrates, such as pasta, whose digestion slowly releases glucose into the intestine for hours.
