Abstract
This case report presents a 9-year-old child without underlying pathology, with a severe life-threatening non-diabetic metabolic ketoacidosis occurring less than 48 h after the onset of fasting and vomiting. The patient was admitted to the pediatric intensive care unit. He received volume expansion and maintenance fluid therapy which allowed a favorable evolution. Because of the unusual rapid onset of intense ketonemia and acidosis, a hereditary metabolic disease was investigated. The association between short fasting period and severe metabolic ketoacidosis has never been described in children outside of the neonatal period. This clinical case emphasizes urgent recognition, rigorous diagnostic and appropriate management in clinical practice.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Data availability
Data will be made available on reasonable request.
Abbreviations
- AG:
-
Anion Gap
References
Jung B, Martinez M, Claessens Y-E, et al., et al. Diagnostic et prise en Charge de l’Acidose Métabolique recommandations formalisées d’experts communes Société de réanimation de langue française (SRLF)– Société française de médecine d’urgence (SFMU). Méd Intensive Réa. 2019;28(6):481–502.
Kraut JA, Madias NE. Metabolic acidosis: pathophysiology, diagnosis and management. Nat Rev Nephrol. 2010;6(5):274–85.
Shah P, Isley WL. Ketoacidosis during a low-carbohydrate diet. N Engl J Med. 2006;354(1):97–8.
Mubarik A, Jupalli A, Iqbal AM, Muddassir S, Eddib A. Isolated starvation ketoacidosis: a Rare cause of severe metabolic acidosis presenting with a pH less than 7. Cureus. 2019;11(2):e4086.
Mostert M, Bonavia A. Starvation ketoacidosis as a cause of unexplained metabolic acidosis in the Perioperative Period. Am J Case Rep. 2016;17:755–8.
Zhou W, Luo L. Preoperative prolonged fasting causes severe metabolic acidosis: a case report. Med (Baltim). 2019;98(41):e17434.
Sinha N, Venkatram S, Diaz-Fuentes G. Starvation ketoacidosis: a cause of severe anion gap metabolic acidosis in pregnancy. Case Rep Crit Care. 2014;2014:906283.
Monnier D, Goulenok T, Allary J, Zarrouk V, Fantin B. Cétose de jeûne chez une femme allaitante [Starvation ketosis in a breastfeeding woman]. Rev Med Interne. 2015;36(12):854–8.
Chan KH, Ramahi A. A rare case of severe starvation-induced ketoacidosis in a patient with recurrent pancreatitis. Cureus. 2020;12(3):e7368.
Millar R, Chiappazzo A, Palmer B. Starvation ketosis in the Pediatric Emergency Department: a prospective Estimate of Prevalence. Pediatr Emerg Care. 2022;38(1):e147–50.
Dennhardt N, Beck C, Huber D, et al. Impact of preoperative fasting times on blood glucose concentration, ketone bodies and acid-base balance in children younger than 36 months: a prospective observational study. Eur J Anaesthesiol. 2015;32(12):857–61.
Cahill GF Jr. Fuel metabolism in starvation. Annu Rev Nutr. 2006;26:1–22.
Ludwig DS, Peterson KE, Gortmaker SL. Relation between consumption of sugar-sweetened drinks and childhood obesity: a prospective, observational analysis. Lancet. 2001;357(9255):505–8.
Bremer AA, Auinger P, Byrd RS. Relationship between insulin resistance-associated metabolic parameters and anthropometric measurements with sugar-sweetened beverage intake and physical activity levels in US adolescents: findings from the 1999–2004 National Health and Nutrition Examination Survey. Arch Pediatr Adolesc Med. 2009;163(4):328–35.
Labarthe F, Willot S, Roullet-Renoleau N, et al. Nutrition des maladies métaboliques rares en pédiatrie. Réanimation. 2010;19(5):441–7.
Semler MW, Self WH, Rice TW. Balanced crystalloids versus saline in critically ill adults. N Engl J Med. 2018;378(20):1951.
Lehr AR, Rached-d’Astous S, Barrowman N, et al. Balanced Versus Unbalanced Fluid in critically Ill children: systematic review and Meta-analysis. Pediatr Crit Care Med. 2022;23(3):181–91.
Wolfsdorf JI, Glaser N, Agus M et al. (2018). Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State: A Consensus Statement from the International Society for Pediatric and Adolescent Diabetes. Pediatric Diabetes. 2018;19(27):155–177.
Van de Voorde P, Turner NM, Djakow J, et al. European Resuscitation Council guidelines 2021: paediatric life support. Resuscitation. 2021;161:327–87.
Funding
No funding was secured for this study.
Author information
Authors and Affiliations
Contributions
Dr C.R conceptualized and designed the study, drafted the initial manuscript, and critically reviewed and revised the manuscript. Drs C.F, C.A, C.L, A.A and I.G collected data, carried out the initial analyses, and critically reviewed and revised the manuscript. Dr D.B conceptualized and designed the study, coordinated and supervised data collection, and critically reviewed and revised the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
Corresponding author
Ethics declarations
Conflict of interest
All authors have no conflicts of interest to disclose.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Roulland, C., Le Pallec, C., Faucon, C. et al. A severe pediatric life-threatening metabolic ketoacidosis. J Diabetes Metab Disord (2024). https://doi.org/10.1007/s40200-024-01410-w
Received:
Accepted:
Published:
DOI: https://doi.org/10.1007/s40200-024-01410-w