User:Baflyer2/Ketotic hypoglycemia
Ketotic hypoglycemia refers to a state of low blood glucose that is accompanied by ketosis, the presence of ketone bodies in the blood or urine. This state can be either physiologic or pathologic; physiologic ketotic hypoglycemia is a common cause of hypoglycemia in children, often in response to stressors such as infection or fasting. Pathologic ketotic hypoglycemia is typically caused by metabolic defects, such as glycogen storage disorders.[1]
 | This is the sandbox page where you will draft your initial Wikipedia contribution.
If you're starting a new article, you can develop it here until it's ready to go live. If you're working on improvements to an existing article, copy only one section at a time of the article to this sandbox to work on, and be sure to use an edit summary linking to the article you copied from. Do not copy over the entire article. You can find additional instructions here. Remember to save your work regularly using the "Publish page" button. (It just means 'save'; it will still be in the sandbox.) You can add bold formatting to your additions to differentiate them from existing content. |
Causes
[edit]Physiologic ketotic hypoglycemia
[edit]The body's physiologic response to falling glucose levels is a suppression of insulin secretion from the pancreas, which decreases the amount of glucose available to most tissue but instead prioritizes the remaining amount for the brain.[1] Hormones such as glucagon, cortisol, and adrenaline are then released to stimulate glycogenolysis and gluconeogenesis in the liver, in addition to lipolysis in adipose tissue. As glycogen stores start to be depleted, the liver begins oxidizing fatty acids to ultimately yield ketone bodies, which can serve as an alternative fuel source for the brain in the absence of glucose.[2] Therefore, the combination of low glucose (hypoglycemia) and the presence of ketone bodies yields the state known as ketotic hypoglycemia. Such a physiologic response is common in adults during periods of fasting, and is particularly common in ill younger children who cannot tolerate long periods of fasting.[3] Episodes of physiologic ketotic hypoglycemia in children decrease with increasing age, presumably because fasting tolerance improves with increasing body mass. Such episodes are rare after the age of nine; persisting episodes past this age should raise suspicion for an underlying pathologic cause.[3]
Pathologic ketotic hypoglycemia
[edit]Pathologic causes of ketotic hypoglycemia, in which episodes persist in children despite increasing age, include glycogen storage defects, disorders of fatty acid metabolism, and disorders of gluconeogenesis, among several others.[1][3] In essence, any metabolic defect that interferes with the body's ability to maintain glucose homeostasis can trigger ketotic hypoglycemia.[1]
Signs and symptoms
[edit]Diagnosis
[edit]Ketotic hypoglycemia is a diagnosis of exclusion.
The advocacy organization Ketotic Hypoglycemia International defines pathologic ketotic hypoglycemia as recurrent, symptomatic episodes in which patients have beta-hydroxybutyrate levels ≥ 1.0 mmol/L and blood glucose levels < 70 mg/dL in the absence of triggers that would otherwise explain ketotic hypoglycemia.[1]
Natural history
[edit]Treatment
[edit]The mainstay of physiologic ketotic hypoglycemia treatment typically includes management of the underlying cause, fluid resuscitation, and dietary supplementation of sugars and carbohydrates.[1] In children, alanine — a precursor in gluconeogenesis — can be infused to rapidly increase plasma glucose levels.[3]
References
[edit]- ^ a b c d e f Drachmann, Danielle; Hoffmann, Erica; Carrigg, Austin; Davis-Yates, Beccie; Weaver, Valerie; Thornton, Paul; Weinstein, David A.; Petersen, Jacob S.; Shah, Pratik; Christesen, Henrik Thybo (2021-04-13). "Towards enhanced understanding of idiopathic ketotic hypoglycemia: a literature review and introduction of the patient organization, Ketotic Hypoglycemia International". Orphanet Journal of Rare Diseases. 16 (1): 173. doi:10.1186/s13023-021-01797-2. ISSN 1750-1172. PMC 8045369. PMID 33849624.
{{cite journal}}: CS1 maint: PMC format (link) CS1 maint: unflagged free DOI (link) - ^ Ruppert, Philip M.M.; Kersten, Sander (2023-11). "Mechanisms of hepatic fatty acid oxidation and ketogenesis during fasting". Trends in Endocrinology & Metabolism. doi:10.1016/j.tem.2023.10.002. ISSN 1043-2760.
{{cite journal}}: Check date values in:|date=(help) - ^ a b c d Kliegman, Robert M.; Nelson, Waldo E., eds. (2020). Nelson textbook of pediatrics. volume 2: Volume 2 (Edition 21 ed.). Philadelphia, Pa: Elsevier. ISBN 978-0-323-52950-1.