Acetone odor in a child's breath

When parents smell acetone from their child's mouth, the question arises: what are the reasons? Do not delay in seeking medical help: this symptom is a signal of a malfunction of the child's endocrine system and the development of serious metabolic pathologies.

Causes of acetone odor on the baby's breath.

The main reasons are related to problems with fat and carbohydrate metabolism – ketosis (ketogenesis) and ketone body catabolism. When, due to a lack of insulin, the body does not have enough glucose to obtain energy, the burning of accumulated fats (which are in the form of triglycerides in the cells of adipose tissue) begins. This biochemical process occurs with the formation of by-products – ketone bodies (ketones). In addition, with a deficiency of insulin, the utilization of ketones in muscle tissue cells decreases, which also increases their content in the body. Excess ketone bodies are toxic to the body and lead to ketoacidosis with the smell of acetone when exhaled, which can be:

• in type 1 diabetes mellitus (insulin-dependent, of autoimmune etiology);
• in congenital syndromes that are accompanied by insulin deficiency and carbohydrate metabolism disorders (including Lawrence-Moon-Bardet-Biedl, Wolfram, Morgagni-Morel-Stewart, Prader-Willi, Klinefelter, Lynch-Kaplan-Henne, McQuarrie syndromes);
• in case of functional renal failure (in particular, with a decrease in the glomerular filtration rate);
• with a deficiency of certain liver enzymes;
• in case of severe dysfunction of the pancreas and adrenal glands of the child;
• with high levels of thyroid hormones caused by hyperthyroidism (including pituitary).

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Risk factors

Risk factors for the appearance of an acetone odor include infectious diseases with a significant increase in temperature, persistent infections, helminthic invasion, and stressful conditions.

At a younger age, a risk factor is also insufficient nutrition of children with a lack of the necessary amount of carbohydrates. Ketosis can also be triggered by the consumption of large amounts of fat, as well as physical overload.

It should be borne in mind that the trigger for the development of autoimmune diabetes mellitus in children can be the frequent use of corticosteroids (which have a negative effect on the adrenal cortex) and antiviral agents containing recombinant interferon alpha-2b.

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Pathogenesis

The presence of acetone odor from the mouth of a child or teenager indicates acetonemia (hyperacetonemia) - an excess of ketones in the blood. When oxidized, they reduce the pH of the blood, that is, increase its acidity and lead to acidosis.

The pathogenesis of hyperacetonemia and ketoacidosis in diabetes mellitus is caused by insulin deficiency and hypoglycemia, which leads to increased lipolysis - the breakdown of triglycerides into fatty acids and their transportation to the liver. In hepatocytes, they are oxidized to form acetyl coenzyme A (acetyl CoA), and its excess forms ketones - acetoacetic acid and β-hydroxybutyrate. The liver cannot handle such a large amount of ketones, and their level in the blood increases. Then, acetoacetic acid undergoes decarboxylation to dimethyl ketone (acetone), which is excreted from the body through the lungs, sweat glands and kidneys (with urine). With an increased amount of this substance in the exhaled air, the smell of acetone is felt from the mouth.

For oxidation of fatty acids, cellular and membrane enzymes are necessary (CoA transferase, acyl-CoA dehydrogenase, β-thioketolase, carnitine, carnitine acyltransferase, etc.), and their genetically determined deficiency in congenital syndromes is the leading cause of ketone metabolism disorders. In some cases, mutations in the gene of the liver enzyme phosphorylase located on the X chromosome are to blame, leading to its deficiency or decreased activity. In children aged one to five years, the presence of a mutant gene is manifested by both the smell of acetone from the mouth and growth retardation and hepatomegaly (enlarged liver). Over time, the liver size normalizes, the child in most cases begins to catch up with peers in height, but fibrous septa may form in the liver and signs of inflammation may be present.

The development of ketoacidosis in cases of increased production of thyroid hormones in hyperthyroidism is explained by a disorder of fat and protein metabolism, since thyroid hormones (thyroxine, triiodothyronine, etc.) not only accelerate general metabolism (including protein breakdown), but can also form insulin resistance. Studies have revealed a strong genetic predisposition to autoimmune thyroid pathologies and type 1 diabetes.

And when there is an excess of fat in the food consumed by children, the transformation of fatty acids into triglycerides in the cytosol of adipose tissue cells is hindered, which is why some of them end up in the mitochondria of liver cells, where they are oxidized to form ketones.

Symptoms of acetone odor on the baby's breath.

In case of ketoacidosis and hyperacetonemia in a child, this smell is far from the only symptom.

If a child has a slight smell of acetone in his mouth, then there may be increased thirst and dry mucous membranes in the oral cavity. Perhaps the child has tonsillitis or acute respiratory viral infection with a fever, or he has been running too much or is overexcited. However, we must not forget that this smell and thirst are the first signs of the development of insulin-dependent diabetes and a mild form of diabetic ketoacidosis.

As endocrinologists note, metabolic disorders in childhood can lead to acetonemic syndrome, when a child has the smell of acetone from the mouth and vomiting, as well as general weakness, decreased appetite, decreased diuresis, nausea, abdominal and headaches. Read more about the etiology and symptoms in a separate publication - Acetonemic syndrome

A sharp deterioration of this condition - with severe acetonemic vomiting, a significant increase in the level of ketones in the blood plasma and urine, slight hyperthermia, shallow breathing and increased heart rate - is called an acetonemic crisis. Its main danger is dehydration of the child's body, since vomiting attacks are multiple during the day and can last for more than one day.

Complications and consequences

Type 1 diabetes mellitus often occurs in childhood and can be complicated by episodes of diabetic ketoacidosis, a severe condition of absolute or relative insulin deficiency leading to hyperglycemia, hyperacetonemia, and systemic inflammation. Possible consequences and complications of this condition in children include disruption of acid-base homeostasis: the level of ketones increases in the urine (which is defined as ketonuria), and along with their excretion in urination, the level of electrolytes (K and Na ions) in the plasma decreases.

Cerebral edema (about 1% of cases), acute ischemic or hemorrhagic stroke, pulmonary interstitial edema, and coagulopathy (due to impaired clotting factors) are also possible.

In addition, as with any increase in blood acidity, the endothelium of blood vessels may suffer: oversaturation of blood with ketone bodies increases the negative impact of free radicals on cells and leads to oxidative stress. It is believed that ketones, or rather their increased level, are related to the occurrence of oncologic pathologies.

In acetonemic syndrome, there is a possibility of liver enlargement and fatty infiltration, and in severe acetonemic crises, the risk of coma and death cannot be ruled out.

Diagnostics of acetone odor on the baby's breath.

If a child has an acetone smell from his mouth, diagnostics are aimed at identifying its cause. This requires tests:

• general clinical tests of blood, urine and feces;
• Blood and urine tests for glucose levels.
• blood test for pH level, β-hydroxybutyrate, electrolytes, phosphates, creatinine;
• urine test for dimethyl ketone levels.

The diagnosis is confirmed by the presence of high blood glucose levels along with abnormal ketones and blood acidosis. Potassium, bicarbonate, and phosphate depletion are typically present.

See also: Diagnosis of Diabetes Mellitus

A blood test is performed to check the level of thyroid hormones (T3, T4 and TSH) and the presence of antibodies to them. Instrumental diagnostics in case of suspected hyperthyroidism is performed using X-ray or ultrasound examination (US) of the thyroid gland. It may be necessary to perform an instrumental examination of the pancreas, liver and kidneys.

Differential diagnosis

Differential diagnosis includes hyperammonemia and hyperosmolar hyperglycemic state (a complication of diabetes); acenonemic vomiting should be differentiated from vomiting in other diseases, including infectious ones.

Treatment of acetone odor on the baby's breath.

Treatment of acetone odor from the mouth of a child consists of treating the diseases in which this odor appears. In case of diabetes, the child needs insulin injection, see – Treatment of diabetes

For methods of reducing the negative impact of excess thyroid hormones used in modern endocrinology, read the publication – Treatment of hyperthyroidism

In case of hyperketonemia and ketoacidosis, foods containing fats should be excluded from the child’s diet: this will reduce the intake of fatty acids and significantly facilitate the liver’s work.

As a rule, vitamin B12 (injections) and such drugs as Methionine (L-methionine, Methion, Thiomendone, Acimetion) are prescribed - only in the absence of hepatitis, serious liver problems and hepatic encephalopathy: 0.25 g three times a day (before meals, with milk) - for children under two years old; 0.4 g - for children two to five years old; 0.5 g - for children over six (the duration of use is determined by the doctor). The drug can cause nausea and vomiting.

If the child has an acetone smell from the mouth and vomiting, it is recommended to wash the stomach with a weak soda solution and drink more - often, but in small portions (one or two tablespoons). Use a 5% glucose solution, a solution of baking soda (a teaspoon per 250 ml of water) and a 0.9% sodium chloride solution (18 g of table salt per 200 ml of water). Children under two years of age can be given enemas with glucose and saline solution (a single dose should not exceed 20-25 ml). Severe conditions, in particular, acetonemic crisis, require hospitalization and intravenous administration of saline and glucose.

For rehydration – compensation of fluid during vomiting – Regidron is used, as well as alkaline mineral waters (without gas) at the rate of 100-120 ml of liquid for each kilogram of the child's body weight. More information in the material – Vomiting in a child

It is not safe to carry out folk treatment of hyperacetonemia, especially since it will not eliminate the causes of the acetone smell. But the advice to give the child cranberry juice, dried apricot or quince decoction, as well as green tea with lemon added - to replenish fluid during vomiting - can be taken. And herbal treatment allows the use of decoctions of chamomile flowers, string grass, chicory root or angelica medicinal - two or three tablespoons several times during the day for nausea and vomiting.

Prevention

Is it possible to prevent the appearance of acetone odor from the mouth of a child? Only by treating diabetes, which increases the level of ketones in the blood. To do this, you need to use insulin therapy and regularly check the child's blood sugar level, as well as drink enough fluids. If the child has diabetes, then certain nutritional rules should be followed, and for this there is a Diet for Type 1 Diabetes

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Forecast

Experts give an accurate prognosis only regarding acetonemic syndrome in children: as a rule, complete recovery is observed with age. In very rare cases of acetonemic crisis, a fatal outcome may occur due to respiratory paralysis and cardiac arrest.

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