suspect ketotic (fasting) hypoglycemia in almost 7 year old - anyone with experience?

[odinsmama]

So I don't know if I'm just grasping here, but I ran across info on ketotic hypoglycemia when doing a search for "vomiting no fever" and it sounds like it could fit our situation.

We don't have a LOT of these episodes, but occasionally my son, who will be 7 at the end of Oct, will vomit first thing in the morning.  It is all liquid, slightly yellow.  I haven't kept track of whether or not he has a fever with these or diarrhea because I just thought he might be more sensitive to stomach viruses than the rest of us or something along those lines.

But last week Wed. he vomited twice in the morning, had no fever and no diarrhea.  A little bite of a strawberry made him vomit again the second time.  Eventually he could sip on water again and he was fully eating by 2:30 that afternoon.  I made him rest and didn't give him anything heavy to eat, assuming it was a virus.

After that he was fine for a full week, no diarrhea, no vomiting, no virus symptoms of any kind.  None of the rest of us had any symptoms.

Now this morning he woke up and vomited first thing and then once more.  He was ready to start eating and drinking again by 9:30 this morning and has kept everything down.  Again, no fever and no diarrhea.

Once I found the info on the ketotic hypoglycemia I saw that not eating enough the night before (which he didn't last night) can cause this to happen.  I know there have been other times when he has only eaten a very small amount of dinner but didn't vomit the next day, so it doesn't seem to be an every time thing.  Though maybe he ate less carbs during the day, or less overall during the day... I'll have to start paying closer attention.

We eat relatively healthy but this boy loves bread and I just decided to cut it out recently (I have GI issues and my younger son stays away from bread so I wonder if it's just not good for him and his body is telling him not to eat much of it).  I haven't even cut it out completely yet, as I'm not going to throw out what we have in the house, I'm just not buying any new stuff.  That is the only diet change I've made and it hasn't even really been implemented yet.

He eats lots of fruit and a little bit of meat.  Will eat certain veggies and will drink veggie juice when we do it.  Will eat sushi (not raw) and beans and cheese and yogurt and eggs...  

He mainly seems to be "picky" at dinner time and is really just not a lover of meat or veggies.  This ends up in him eating only a very small portion of the dinner, or me feeling like I need to make him beans every night to guarantee he'll eat a decent sized meal.  This is not something I've ever done, I've always served dinner and that's it.  I don't do the restaurant kitchen.  Obviously if it's a real health issue, I'll modify this policy.

So, questions...

Does anyone have any experience with this?  Do I need to start to monitor his glucose?

I read that it can't really be diagnosed, just other things ruled out... anyone have experience taking this theory to a doctor with success?

I also read that a bed time snack will be helpful, any ideas for this that don't involve flour products?

I'm also willing to have bread in the house for him, if this is going to help him, and just give him a peanut butter toast at night after his brother goes to bed.

[KeliG]

I don't know about ketotic hypoglycemia but in some ways it sounds similar to a genetic disorder that runs in my family called Medium-chain acyl-CoA dehydrogenase, or MCAD, deficiency. It is the inability to convert certain types of fat to energy, particularly during fasting. Symptoms include stomach upset, vomiting, low blood sugar, etc. For children even an over night fast can be enough to trigger it. The more extreme symptoms are scary but if a person knows about it there is little risk of them occurring because it's easy to manage.

I found out about it during a genetic test. I am a "symptomatic carrier". So I have one copy of the gene and have milder symptoms that sound very similar to what you described. Fasting longer than 6 hours often makes me feel strange and hunger sometimes just feels yucky and I don't want to eat so as a kid I often skipped meals or didn't eat enough. That just makes symptoms worse though. Frequent protein + complex carb snacks help (I guess the extra doses of short and long chain fatty acids are making up for the medium chain) as does a supplement called L-carnitine at a dose of one gram a day. I have no idea if that supplement is safe for kids, that is just what has worked for me. If I have to fast for surgery or something I request IV with glucose instead of Saline.

The test to find it was just a saliva test that I mailed off to a company in California, and it was covered by insurance. There are also short and long chain versions of the disorder. Hope this helps!
Edited by KeliG - 8/7/12 at 3:13pm

[pek64]

Ginger tea works great with vomiting and can get him back on track quickly in the morning
I didn't read the whole post, so I may have missed something, but is he eating dinner too long before bedtime, or not eating enough at dinner?

Traditional Medicinals makes a ginger and a ginger aid tea. Either should work. You can make it the night before and give it to him first thing already cool.

Good luck! Hope the tea helps.

[leafylady]

My daughter used to do that but I thought it was excess acid at night building up, a sort of reflux. She grew out of it after 3 or so years. It didn't happen all the time. She ate plenty of food so I tried to make sure she avoided junky food at night.

[sbgrace]

My son does have low blood sugar in the morning. They found it in testing for metabolic disorders (turns out he does have one that involves processing of fat for energy in the mitochondria). He does need carbs for energy. He was vomiting some like you describe. He would also be extremely agitated when his blood sugar would drop into the low 70's (so not hypo yet) but i never noticed behavioral changes once he actually went hypoglycemic on the blood monitor. it was that between stage that affected his emotional stability. That meant we made sure he ate every 2.5 hours or so during the day. I didn't have the emotional stuff in the mornings but he would sometimes throw up and never wanted to eat in the morning. The geneticist told me the lack of appetite was likely related to the low blood sugar. He might be nauseous for example but just thought it was normal. So we didn't see vomiting all the time but the low blood sugar was there.

The doctors told us to do corn starch before bed. It digests really slowly. I just couldn't get it in him and, because my son spills ketones like crazy, the doctor wasn't concerned about damage from the hypoglycemia. We do a before bed snack and it does have carbs. What it is varies but it always involves yogurt (protein/fat/carbs) and something straight up complex carbs.

I'd be inclined to not cut the bread for your son given he might well not be cut out for a protein/fat based diet. He may need the carbs for energy. Is he otherwise healthy, has normal energy, and is developing well?

[odinsmama]

thank you!!!

He's otherwise a healthy, happy kid.  His development is fine, he's smart and creative.  I did check a BMI calculator and he is at the low end of the weight chart, though my home scale is definitely not totally accurate.  I think he's also going through a growth spurt and is looking very tall these days.

We definitely have some off-normal behavior times.  I always chalked it up to him being (maybe) tired, even though he has a relatively early bed time.  The behavior is just really hyper, loud, tending to point and use silly sounds instead of words, really being in his brother's face and not backing off, bugging the dog etc...  When I talk to him in one of these moods I can just see he's not hearing me.  I'd think he needed a nap if he were younger or going to bed later.  

He happens to be in one of these moods today and food doesn't seem to be helping.  I've given him a variety of carbs/protein and some bread as well as some cornstarch in a drink.  

I don't test his blood at all but tested his urine yesterday (I have strips on hand because I'm testing during pregnancy) and his ketones were in the 40 range until the end of the day.

I still really don't know exactly what that means.

[pek64]

Thinking about you. Hope all of you are doing better.