Ketone bodies (ketones) in the urine of the child

At the root of many diseases that can suffer the adult, are laid in childhood, mechanisms that violate the normal course of various metabolic processes. Ketone bodies in the urine of the child can witness both the development of acetonemic syndrome, and disorders of the nervous system and related disorders metabolism.

Causes of ketones

The appearance ketonovyh bodies in the urine of the child shows the development of acetonemic syndrome. This condition in children is a complex of symptoms resulting from increasing the concentration in blood products resulting from lipid oxidation.

In the process of fat oxidation are formed three kinds of ketone bodies:

• of propanone (acetone);
• acetoacetate (acetoacetic acid);
• beta-hydroxybutyrate (beta-hydroxybutyric acid).

The increase in the blood content of acetone becomes the cause of acidosis, accompanied by periodic bouts of vomiting alternating periods of relatively normal health.

As a rule, Academichesky syndrome is diagnosed on average 5% of children in the age range from 1 year to 13 years. In girls, the syndrome occurs 1.2 times more frequently than boys.

Development acetonemic syndrome is necessarily accompanied by ketonuria, with the increase of ketones in the urine of the child of more than 500 mg/L. The development of acidosis usually occurs in slender, energetic, excitable children

There are several reasons that triggers the development of acidosis in children:

• a stressful situation, accompanied by a failure in the hormonal system;
• eating fatty foods;
• irregular meals, with a long “hungry” periods.
• diseases of the endocrine system (hyperthyroidism, diabetes).

Regardless of what the causes are caused by carbohydrate deficiency, to replace the energy needs, the activation process of fat metabolism, accompanied by release of fatty acids from fatty depot.

They all originate in the liver, transforming into a transitional form – acetoacetic acid (acetyl coenzyme A), which partially uses the body as an energy reserve.

Unused acetoacetic acid undergoes a series of transformations, becoming partially cholesterol and ketone bodies.

Increasing the concentration of acetoacetic acid sverhdorogimi values, affects the process of its transformation into energy, as it inhibits the activity of enzymes that stimulate its transformation. In the end, the body is the only possible way of removing the acetyl-coenzyme A the formation of ketone bodies.

The higher the concentration of ketones in the blood plasma, the harder it is to normalize energy metabolism, because the metabolic disorder is complicated by toxic effects of acetone on the body.

Ketoacidosis in a child, over time, can lead to the development of gout

Classification

Since, the detection of ketones in the urine, the child shows the development of a pathological state, acetonemic syndrome is also considered to be not a disease but a symptom.

Depending on the pathologies that cause metabolic disorders, acetonemic syndrome are divided into 2 types:

• primary (of unknown origin or idiopathic);
• secondary (pathological).

The primary syndrome should be considered as an independent disease resulting from nervous-arthritic diathesis (neuro-arthritic anomaly of the Constitution).

Children with such a tendency, characterized as:

• too excitable;
• overly active;
• emotional;
• curious.

In addition, in this state, in the body of the child noted the following violations associated with a genetic predisposition:

• lack of enzymatic function of the liver;
• disorders of lipid metabolism;
• disorders of carbohydrate metabolism;
• endocrine disorders;
• disorders of uric acid metabolism.

Diathesis is a consequence of genetic disorders and is a standard reaction of the body (abnormal) to ordinary stimuli.

Not to be confused with neuro-arthritic diathesis with redness of the skin in children (allergic diathesis)

Secondary syndrome is a consequence of an existing acute conditions or disease. As a rule, the cause that caused the development acetonemic syndrome easy to identify and to develop treatment strategies aimed at addressing the root causes of ketoacidosis.

To pathological conditions, can cause ketoacidosis, include:

• diabetes mellitus;
• the post-operative condition;
• infectious diseases.

The negative impact of ketone bodies in the body of the child

The development of ketoacidosis is always associated with a number of factors that have a negative impact on the child’s body, causing vomiting, dehydration and pain.

1. If ketones are elevated, there occurs acidification of the body and develops ketoacidosis. When you try to compensate for lost alkaline reserve, the body begins to get rid of carbon dioxide by intensive hyperventilation of the lungs that causes a spasm of cerebral vessels.
2. A large number of ketone bodies reduces the conductivity of the Central nervous system, sometimes with subsequent development of coma.
3. The lack of oxygen in large quantity used for getting rid of ketones contributes to further deterioration.
4. Increased concentration of ketone bodies has an irritating effect on the mucous membrane of the stomach and intestines which provokes vomiting, and abdominal pain.
5. Acetone has a destructive effect on cell membranes.

The complex of negative impacts is complemented by dehydration, metabolic lactic acid, which greatly complicates the course of illness, and complicates treatment.

Rate the content of ketones in the urine, the child is not more than 50 mg/l

To compensate for dehydration, it is recommended to drink the drug Regidron

Symptoms

Due to the fact that ketosis may be accompanied by another pathological condition, the clinical picture consists of the symptoms of ketosis, and manifestations of pathology it provoked.

Symptoms of ketoacidosis include:

• nausea;
• vomiting;
• lack of appetite;
• the smell of acetone breath and urine;
• lethargy;
• irritability;
• dry skin (a sign of dehydration);
• weight loss;
• heart palpitations;
• noisy breathing;
• pain in the epigastric region;
• the increase in body temperature.

In the initial stages of the disease the symptoms are so insignificant that they often do not attach importance to. However, in a relatively short period of time, their intensity is growing, getting the critical value.

Diagnosis

Diagnosis of the disease relies on 3 criteria:

• the results of the study of the history of the patient;
• analysis of existing complaints and symptoms;
• the data of laboratory researches.

At diagnosis, it is necessary to apply a differentiated approach, as it is important to exclude possible diseases with similar symptomatic picture:

• brain tumor;
• infectious diseases;
• acute surgical condition;
• pathological conditions of the digestive system

Neoplastic lesions of the Central nervous system are always accompanied with severe vomiting

The results of laboratory research methods primarily include urinalysis and a blood test. If in the results there are no changes characteristic of pathologies that can cause symptoms of ketoacidosis (eg, increased sugar), then it is possible to diagnose primary Academichesky syndrome.

The most significant feature is the detection of ketones in the urine, in an amount of from 50 to 1000 mg/l. Also, in connection with dehydration in the blood and urine can increase the concentration of uric acid and protein.

Detection of glucose in urine is not always a consequence of diabetes, as it can be due to intravenous infusion of glucose to compensate for the lack of carbohydrates.

Treatment

Treatment acetonemic syndrome in children is carried out taking into account the existing pathological and physiological disorders and includes the following areas:

1. Limit fat intake.
2. Enrichment of the diet with carbohydrates.
3. The use of enzymes to enhance the absorption of carbohydrate foods – kokarboksilaza, vitamin b₁, vitamin b₆.
4. Intravenous infusion of sodium chloride (rehydration and has alkalizing effect), glucose (removes the deficit of carbohydrates).
5. The use of antibiotics (by prescription).

If the concentration of ketone bodies does not exceed 500 mg/l and is not accompanied by serious violations, in the form of repeated vomiting, the appointment shall be limited to diet therapy in combination with medications that have the effect of rehydration (Rehydron).

High efficiency in the treatment of ketosis are solutions of sorbitol or xylitol as the process of turning them into energy is excellent from glucose

If you suspect a child has a neuro-arthritic anomalies of the Constitution should observe the dietary restrictions, organize meal times, eliminate long breaks between meals. Upon reaching the age limit 12-14 years (adolescence), the risk of developing acetonemia crises will disappear.