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A Cause of Permanent Ketosis: GLUT-1 Deficiency

  • Alexis Chenouard
  • Sandrine Vuillaumier-Barrot
  • Nathalie Seta
  • Alice Kuster
Case Report
Part of the JIMD Reports book series (JIMD, volume 18)

Abstract

GLUT-1-deficiency syndrome (GLUT1-DS; OMIM 606777) is a treatable metabolic disorder caused by a mutation of SLC2A1 gene. The functional deficiency of the GLUT1 protein leads to an impaired glucose transport into the brain, resulting in neurologic disorders.

We report on a 6-month-old boy with preprandial malaises who was treated monthly by a sorcerer because of a permanent acetonemic odor. He subsequently developed pharmaco-resistant seizures with microcephaly and motor abnormalities. Metabolic explorations were unremarkable except for a fasting glucose test which revealed an abnormal increase of blood ketone bodies. At the age of 35 months, GLUT1-DS was diagnosed based on hypoglycorrhachia with a decreased CSF to blood glucose ratio, and subsequent direct sequencing of the SLC2A1 gene revealed a de novo heterozygous mutation, c.349A>T (p.Lys117X) on exon 4. It was noteworthy that the patient adapted to the deficient cerebral glucose transport by permanent ketone body production since early life. Excessive ketone body production in this patient provided an alternative energy substrate for his brain. We suggest a cerebral metabolic adaptation with upregulation of monocarboxylic acid transporter proteins (MCT1) at the blood–brain barrier provoked by neuroglycopenia and allowing ketone body utilization by the brain. This case illustrates that GLUT1-DS should be considered in the differential diagnosis of permanent ketosis.

Keywords

Ketone Body Ketogenic Diet SLC2A1 Gene Organic Acidemia Ketone Body Production 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© SSIEM and Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Alexis Chenouard
    • 1
  • Sandrine Vuillaumier-Barrot
    • 2
  • Nathalie Seta
    • 2
  • Alice Kuster
    • 1
  1. 1.Pediatric DepartmentNantes University HospitalNantesFrance
  2. 2.AP-HP, Hospital Bichat-Claude Bernard, Metabolic BiochemistryParisFrance

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