Is sweet-smelling breath a good sign, you think? - Urgent! Help! Update #10 - Mothering Forums
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#1 of 38 Old 11-14-2008, 02:10 AM - Thread Starter
 
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We don't generally brush DD's teeth very often, but her breath always smells good to me...you know how EBF babies' breath does? Kind of like that but not exactly. She is BF, of course, but she also has some issues that make me worry she's not getting the right nutrition. So I guess I'm grasping at straws hoping that this means she is healthy. Or maybe it's a bad sign. Isn't there some condition that gives you sweet-smelling breath? Ketoacidosis? Am I making this up? I think I need to go to bed...

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#2 of 38 Old 11-14-2008, 11:33 AM
 
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Your memory isn't going, that is a sign of ketoacidosis and of early diabetes. It can also be a sign of metabolic issues and of allergies, though I don't know which ones. I just posted a response to another similar question, I would post on the special needs forum, sometimes moms there are familiar with the different reasons these things happen.
Hope that you get an answer soon,
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#3 of 38 Old 11-14-2008, 06:35 PM
 
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I'm sure there are other reasons as well, but since I've had type 1 for 20+ years, ketoacidosis was my first thought.
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#4 of 38 Old 11-14-2008, 10:30 PM - Thread Starter
 
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Oh great. So what exactly does that mean? I guess I need to find a good holistic practitioner to help, because I'm obviously not having success on my own. Would a naturopath be a good choice?

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#5 of 38 Old 11-15-2008, 01:48 AM
 
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If you suspect she might have diabetes I would go to someone who will run the labs to check for diabetes. Did your daughter have a newborn screening for metabolic conditions?

What types of issues does your daughter have? Could you be seeing signs of a metabolic condition?

It's hard to find a doctor knowledgable about metabolics. I think you need to check for diabetes. If that isn't it, I think you need an expanded newborn screen if your daughter didn't have one (and/or a metabolic work up if it is too late for a newborn screen).

I'm particularly concerned because it sounds like you're already seeing signs that are bothering you about her health?

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#6 of 38 Old 11-16-2008, 01:15 AM - Thread Starter
 
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You know what's ironic? She had a blood draw for lead and CBC, and the nurse asked if I wanted to test for anything else, while we were at it. I asked "like what?" And she suggested diabetes. I thought that sounded totally crazy and was like "oh no, we don't need that!"

Other symptoms: Constipation is the main one, but I've seen some little eczema-like rashes once in a blue moon. Lately her skin has had this funny dry texture to it, almost like tiny little bumps that you can't even see. She's also been reeeeeeally hard to put to sleep lately, but her recent difficulties have coincided with our last move, so I just thought it was stress.

I just looked at the symptoms of type 1 and ketoacidosis, and I don't see anything familiar except the sweet-smelling breath. She did have a cough about a month ago that took awhile to go away, and she had a couple of coughing spells after exertion, but it went away and didn't seem serious. She does have a heart murmur that our last doc didn't think was anything to be concerned about.

She's had slightly elevated lead levels that we've never really resolved, but we have moved since then. I had a hair test done that was so crazy off the charts that the only way I could reconcile it was that I did the test wrong and it was tainted.

She had all the normal newborn screenings.

I'll call her old docs on Monday and see if I can get any info and have her chart sent to me. We don't have a doc here in Richmond yet.

What else would I be looking for for a metabolic condition? What are the names of some I could look up?

What should I be feeding her to keep her well at this point? She needs very frequent meals??

I just thought of another symptom that might be relevant. She loves sweets. I feel silly typing that, because, who doesn't? I've always been careful of not giving her sugar, but I think I made the mistake of feeding her basically unlimited amounts of fruit from the time she started solids. Since realizing that she needed a lot more fat and protein to help her constipation, I started to limit fiber, bread, etc. But lately I feel like my DH has been sabotaging my efforts by offering her a lot more fruit, dried fruit, and sweets/baked goods/frozen waffles than I would ever give her in a million years. We've also been eating a lot of french toast for breakfast (with maple syrup) and rice noodles for lunch or dinner. Bananas and dried fruit are her favorite snacks.

Oh, and she's "only" had her 2 month shots.

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#7 of 38 Old 11-16-2008, 02:25 AM - Thread Starter
 
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Can I get urine test strips at the drug store?

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#8 of 38 Old 11-16-2008, 07:24 PM - Thread Starter
 
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I got some urine test strips for ketones. Is this what I want? Should I go ahead?

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#9 of 38 Old 11-16-2008, 10:35 PM - Thread Starter
 
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So, we did the urine ketone test. Hers came out between negative and trace, exactly the same as mine. : Any thoughts on what to do next?

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#10 of 38 Old 11-24-2008, 03:10 PM - Thread Starter
 
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DD has been saying today that her tummy hurts, and hasn't wanted to eat anything all day. She's BFing frequently, but I noticed the "nail polish remover/acetone" smell on her breath that I read about somewhere. I had her pee on another ketone tester, and it is in the moderate to high range!!! Ack!!! What do I do???

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#11 of 38 Old 11-24-2008, 04:38 PM - Thread Starter
 
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Another question I just thought of: the test also talks about how you can use it if you are on a low-carb diet to see if you are in ketosis. What is the difference between ketosis and ketoacidosis? Is it possible she just hasn't had a lot of carbs lately and that has put her into ketosis? What is the danger of that?

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#12 of 38 Old 11-24-2008, 04:46 PM
 
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I think you should take her to a doctor and have her blood sugar tested.

My DH has been type 1 diabetic for a long time now so I have some knowledge of it from him. The urine strips are not as reliable as a blood sugar. They might be able to do a quick test with a finger prick and a blood sugar meter.

How old is she?

Let us know what happens!!
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#13 of 38 Old 11-24-2008, 05:08 PM - Thread Starter
 
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She's 2.5. Thanks!

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#14 of 38 Old 11-24-2008, 05:21 PM
 
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I'd take her to a doctor and have her tested for diabetes. It's a quick blood check and urine dip. My daughter was 2 when she was diagnosed with Type 1 diabetes and it took 5 minutes in the office.

WOHM to DS11 and DD9, both T1Ds

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#15 of 38 Old 11-24-2008, 05:29 PM
 
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Quote:
Originally Posted by leila1213 View Post
Another question I just thought of: the test also talks about how you can use it if you are on a low-carb diet to see if you are in ketosis. What is the difference between ketosis and ketoacidosis? Is it possible she just hasn't had a lot of carbs lately and that has put her into ketosis? What is the danger of that?
There is no danger of ketosis for anybody of any age (barring any metabolic disorders)- the only danger, really, is that it might mask ketoacidosis.

If she eats a lot of sweets, she wouldn't be in the healthy kind of ketosis- that would come from filling up on protein and fat with very few carbs. I'm not sure if breastmilk has few enough carbs (from lactose) compared to the protein and fat to induce ketosis. Maybe give her some juice or fruit and test her urine again?

Ruth, single mommy to Leah, 19, Hannah, 18, and Jack, 12
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#16 of 38 Old 11-24-2008, 05:43 PM
 
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Leila, it would take a severely restricted diet carb wise to put her in ketoacidosis. Breastmilk certainly has too many carbohydrates to cause it. Diet for that has almost no carbs at all and very high fat.

I don't understand what your hesitation is. You have enough symptoms that point to an issue--you need actual medical labs now. She needs to be screened for diabetes. If it isn't that I'd suggest a urine metabolic screen. But diabetes seems like a first step.

There is no reason to wait and in fact if indeed she's in acidosis that can be very dangerous and damaging.

http://www.netdoctor.co.uk/diseases/...eschildren.htm
She has warning signs. You detected possible ketones in the urine. She has sweet smelling breath at times.

Don't wait for her to get sick. Take her to get tested.

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#17 of 38 Old 11-24-2008, 06:02 PM
 
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I have to agree with Rachelle, take her for labs. The tests aren't a big deal at all, and as a pp pointed out took less than 5 minutes in the office to dx.

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There is no reason to wait and in fact if indeed she's in acidosis that can be very dangerous and damaging.
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#18 of 38 Old 11-24-2008, 06:24 PM - Thread Starter
 
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Thank you I will do that this week. I guess I just feel like I'm being a hypochondriac since she has no other symptoms. Also I am scared that we will be starting a cycle that might mean we are doing tests and drugs that necessitate other tests and drugs, and get farther and farther from fixing her diet and the underlying cause. KWIM?

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#19 of 38 Old 11-24-2008, 06:29 PM
 
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You aren't being a hypochondriac at all! She has symptoms that, at the very least, mean you should get a doctor to rule out some very serious possible causes. If it's a false alarm, then great! Pediatricians get those all the time.

Her diet might not be the problem -- if she's Type I diabetic, diet alone won't solve the problem, the underlying cause is genetic.
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#20 of 38 Old 11-24-2008, 06:33 PM
 
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Originally Posted by leila1213 View Post
Thank you I will do that this week. I guess I just feel like I'm being a hypochondriac since she has no other symptoms. Also I am scared that we will be starting a cycle that might mean we are doing tests and drugs that necessitate other tests and drugs, and get farther and farther from fixing her diet and the underlying cause. KWIM?
I totally understand that, but the basic labs can at least rule out serious issues like diabetes and then you can work on addressing the diet issues and underlying causes without having to worry that you're overlooking something serious. And yes, peds (all HCP probably) see plenty of false alarms all the time. In this case, however, I think at least blood sugar levels and urine tests are in order, and if those came back okay then start working on the underlying diet issues or whatever.

keep us posted!
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#21 of 38 Old 11-24-2008, 06:33 PM - Thread Starter
 
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I think I mentioned that we don't yet have a regular dr in the city we're in now. There is a quick clinic right down the street though. Should I just march in and say that we want to test her for diabetes?

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#22 of 38 Old 11-24-2008, 06:53 PM
 
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YES!!!!!!

You are messing around with what could be a VERY serious situation, and one that is also causing you a lot of mental stress. If she is diabetic, you really need to deal with it ASAP. If she is not, you will have a big load off your mind.

Please take her in as soon as possible (like find out if they're open tonight and take her now) and report back. I hate to scare you, but kids with untreated diabetes can get very sick and even die.

Sending you strength,

CGM (RN, MSN in pediatric nursing)

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#23 of 38 Old 11-24-2008, 06:56 PM
 
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Yep, just march in. We use the quick clinic down the street from us all the time because it's so hard to get appointments with a primary care doctor on our insurance, and it is easy as pie. The test shouldn't cost a fortune, either.

Just say "My daughter has these symptoms, X, Y, and Z, that make us concerned about juvenile diabetes. Can you please test her?" They may also have some helpful suggestions for follow-up if it isn't diabetes.
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#24 of 38 Old 11-24-2008, 07:06 PM
 
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better safe than sorry. If she is exhibiting symptoms then what is the harm in taking her in? If it is in fact type 1 diabetes then serious damage if not death can occur without treatment- that wouldn't be something that I (as a non medical professional) would be willing to try to treat myself. Like someone esle said- type 1 diabetes cannot be treated with diet alone.
Test strips are used to monitor blood sugar levels - NOT diagnose a potential disease or lack of disease.

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#25 of 38 Old 11-24-2008, 07:08 PM
 
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Yes, take her in. Even if you feel like you're overreacting.

And hopefully it does turn out that you were overreacting. But so what?? I figure every parent goes through the whole taking them to the doctor and finding out it's nothing once in a while.

They really are not going to care at the clinic. It's not like you're marching in there every day demanding an MRI or an angiogram or something. It's a blood sugar test that takes 5 min.
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#26 of 38 Old 11-24-2008, 08:10 PM
 
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Please go asap! I am a former paramedic and I have been called for a child who was later diagnosed with diabetes, it was very scary. Do not feel silly, you are protecting your DD. The peace of mind in knowing will be priceless.
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#27 of 38 Old 11-24-2008, 08:15 PM
 
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Originally Posted by leila1213 View Post
Thank you I will do that this week. I guess I just feel like I'm being a hypochondriac since she has no other symptoms. Also I am scared that we will be starting a cycle that might mean we are doing tests and drugs that necessitate other tests and drugs, and get farther and farther from fixing her diet and the underlying cause. KWIM?
If she has diabetes you will be starting a cycle of treating your daughter and not letting her die. Sorry to be blunt but possible diabetes is nothing to mess around with. I hope you have taken her to a doctor by the time you read this post.

Shawna, married to Michael, mommy to Elijah 1/18/01, Olivia 11/9/02, and Eliana 1/22/06
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#28 of 38 Old 11-24-2008, 11:21 PM - Thread Starter
 
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OK, so here's the deal. DD took a reeeeeally long nap. I was worried and wanted to take her in to the dr so I got her up and could tell right away that she was feverish. DH also felt feverish and achy yesterday. I did another ketone test of her urine and it was still in the mod/high range. I went to the urgent care clinic (left DD with DH) and talked to a nurse about it. She said that they could do a fasting or postprandial finger stick but that this would probably not a good time to test because of her being sick. Fighting an infection will cause her to spill ketones and sugar into her blood and urine and essentially cause a false positive. So I thought I would take her in tomorrow morning for a postprandial finger stick (since she nurses all night & thus we wouldn't have a reliable fasting time), and also contact a ped in the area to see what they have open. The urgent care clinic felt that a ped would be better suited for any testing more extensive than the finger prick. I would definitely want to get EMLA cream for a blood draw if that is needed. What do you all think?

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#29 of 38 Old 11-24-2008, 11:50 PM
 
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I would say keep a close eye on her and if your "mom sense" tells you to, PLEASE take her to the ER. (disclaimer: I am not in the endocrinology field)

btw, they can test in the blood for Hemoglobin A1C, which gives a three-month view of glucose control, so even if your dd is sick w. a cold now, do not let that be a reason to delay looking into this.

Can you call about seeing a pediatric endocrinologist, who would specialize in kids w. diabetes? You would really want someone to quickly either rule this in and get her treatment, or rule it out and let you get on with your life....

From Wikipedia, here are signs and symptoms of ketoacidosis. Please notice now some/much of what you have described about your dd fits this pattern:

"It is important to note that to an untrained person the symptoms of acute DKA, such as breath odor, are very similar to alcohol intoxication, and it is easy to assume that the person is drunk instead of suffering from a diabetic emergency.

* Sluggishness, extreme tiredness.
* Extreme thirst, despite large fluid intake.
* Constant urination
* Fruity smell to breath, similar to nail polish remover.
* Hyperventilation, at first rapid and shallow, then progressively deeper and less rapid.
* Extreme weight loss.
* Oral Thrush and/or persistent vaginal yeast infections may be present; this is because the normal fungal flora present in the oral cavity and cervix is disrupted
* Muscle wasting.
* Agitation / Irritation / Aggression / Confusion

Late signs

At this point, DKA is life-threatening and medical attention should be sought immediately.

* Emesis (vomiting), although this is not always a sign of late-stage ketoacidosis, and can occur both in early-stage ketoacidosis and in non-ketoacidic hyperglycaemia.
* Confusion.
* Abdominal pain.
* Loss of appetite.
* Flu-like symptoms.
* Lethargy and apathy.
* Extreme weakness.
* Kussmaul breathing ("air hunger"). A type of hyperventilation where patients breathe very deeply at a normal or increased rate. This is a sign of severe acidosis.
* Unconsciousness (a variety of diabetic coma) after prolonged DKA. At this stage, speedy medical attention is imperative."

Again, if you remain concerned during the night, please take her to an ER.

Good luck.

Mama to four great girls: 14 , 12 , 7 and 4
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#30 of 38 Old 11-24-2008, 11:54 PM
 
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Originally Posted by purplepaisleymama View Post
Your memory isn't going, that is a sign of ketoacidosis and of early diabetes. It can also be a sign of metabolic issues and of allergies, though I don't know which ones. I just posted a response to another similar question, I would post on the special needs forum, sometimes moms there are familiar with the different reasons these things happen.
Hope that you get an answer soon,
laura
Hi there! Just as a side note, ketoacidosis has a VERY distinct smell, and at that point your child would be extremely ill. Odds are Ketoacidosis is not what you are dealing with! I really wouldn't worry about that! However, if you feel it's necessary, a simple blood test will help you do figure out whether or not it could be the beginning stages of JD.
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