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Title: Review article: Accelerated starvation of childhood: Have I judged ketones?
Austin Authors: Millar, Robert ;Harding, Anton 
Affiliation: Austin Health, Heidelberg, Victoria, Australia
The University of Melbourne, Melbourne, Victoria, Australia
Epworth Hospital, Melbourne, Victoria, Australia
Royal Children's Hospital, Melbourne, Victoria, Australia
Issue Date: 27-Mar-2019
Date: 2019-03-27
Publication information: Emergency Medicine Australasia : EMA 2019; 31(3): 314-320
Abstract: Acute ketosis is an important physiological mechanism to prevent irreversible neurological damage from hypoglycaemia during starvation, and represents a significant metabolic stress. A cohort of children adapt to relatively short periods of reduced caloric intake by generating large quantities of ketone bodies. When excessive, the gastrointestinal symptoms of starvation ketosis such as nausea and pain may create a vicious cycle that delays spontaneous resolution. The presence of ketones can be dismissed as a normal feature of childhood metabolism, sometimes even when extreme. A broader understanding of this process under the banner of 'accelerated starvation of childhood' is helpful for clinicians managing acute illness in children. We advocate that children less than 7 years of age with a history suggestive of accelerated starvation of childhood should be screened by emergency clinicians for ketosis using a simple and cheap bedside capillary test, even if glucose levels are greater than 2.6 mmol/L. Identification and appropriate management of ketosis may alleviate the distressing gastrointestinal symptoms associated with many minor illnesses, and potentially prevent hypoglycaemia in some children. Appropriate advice to carers may be helpful to prevent further episodes. Illustrative case examples from our own practice are provided.
DOI: 10.1111/1742-6723.13276
ORCID: 0000-0002-1854-9478
Journal: Emergency Medicine Australasia : EMA
PubMed URL: 30916481
Type: Journal Article
Subjects: child
Appears in Collections:Journal articles

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