Acetonemic syndrome

Acetonemic syndrome or AS is a complex of symptoms in which the blood level of ketone bodies (in particular, β-hydroxybutyric and acetoacetic acid, as well as acetone) increases.

They are products of incomplete oxidation of fatty acids, and if their content increases, a shift in metabolism occurs.

Causes acetonemic syndrome

Most often, acetonemic syndrome develops in children aged 12-13. It appears due to the fact that the amount of acetone and acetoacetic acid in the blood increases. This process leads to the development of the so-called acetonemic crisis. If such crises occur regularly, then we can talk about the disease.

As a rule, acetonemic syndrome occurs in children who suffer from neuro-arthritic diathesis, some endocrine diseases (diabetes mellitus, thyrotoxicosis), leukemia, hemolytic anemia, gastrointestinal tract diseases. This pathology often occurs after a concussion, abnormal liver development, brain tumor, starvation.

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Pathogenesis

The pathways of protein, carbohydrate and fat catabolism under normal physiological conditions intersect at certain stages in the so-called Krebs cycle. This is a universal source of energy that allows the body to develop properly.

Thus, carbohydrates that have passed the Embden-Meyerhof glycolytic pathway are converted into pyruvate (an organic keto acid). It is burned in the Krebs cycle. Proteins, in turn, are broken down by proteases into amino acids (alanine, cysteine, and serine are also converted into pyruvate; tyrosine, aspartic acid, and phenylalanine are sources of pyruvate or oxaloacetate; tyrosine, phenylalanine, and leucine are converted into acetyl-Coenzyme A). Fats are also converted into acetyl-Coenzyme A by lipolysis.

During starvation or excessive consumption of protein and fatty foods, constant stress, ketosis develops. If the body, at the same time, feels a relative or absolute deficiency of carbohydrates, then lipolysis is stimulated, which should satisfy the need for energy.

With increased lipolysis, a huge amount of free fatty acids enter the liver. Once there, they begin to transform into acetyl-Coenzyme A. At the same time, its entry into the Krebs cycle is limited due to a decrease in the amount of oxaloacetate (due to a lack of carbohydrates). The activity of enzymes begins to decrease, and this activates the process of synthesis of free fatty acids and cholesterol. As a result, the body has only one way out - to utilize acetyl-Coenzyme A through ketogenesis (synthesis of ketone bodies).

Ketone bodies begin to either oxidize in tissues to the state of water and carbon dioxide, or are excreted by the kidneys, gastrointestinal tract and lungs. That is, acetonemic syndrome begins to develop if the rate of utilization of ketone bodies is lower than the rate of their synthesis.

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Symptoms acetonemic syndrome

Usually children who suffer from acetonemic syndrome are thin, they often suffer from insomnia and neuroses. Sometimes they are very fearful, their nervous system is quickly exhausted. Despite this, such children develop speech, memory, cognitive processes better than other peers.

Acetonemic crises are considered a frequent manifestation of this syndrome. Such conditions usually appear after some precursors: severe lethargy, nausea, migraine-like headaches, poor appetite.

In typical acetonemic syndrome, a common symptom is severe nausea with vomiting, followed by signs of intoxication or dehydration. Usually, after motor restlessness and excitability, the child experiences a period of drowsiness and lethargy. If the disease is severe, convulsions, spasmodic abdominal pain, diarrhea or constipation, and elevated body temperature may occur.

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First signs

As a rule, the first signs of acetonemic syndrome appear at an early age (two to three years). They can become more frequent at seven to eight years. Usually, at the age of twelve to thirteen, all symptoms disappear without a trace.

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Acetonemic vomiting syndrome

Acetonemic vomiting syndrome is a concomitant syndrome with neuroarthritic diathesis. This disease is considered a feature of the structure of the child's body. It is characterized by the fact that mineral and purine metabolism changes. This condition is diagnosed in 3-5% of children. Moreover, in recent years, the number of patients has been constantly increasing.

The main symptoms of acetonemic vomiting syndrome are:

1. Nervous excitability increases.
2. Ketoacidosis.
3. Frequent lipid metabolism disorders.
4. Manifestation of diabetes mellitus.

Heredity plays a very important role here. If the child's relatives were diagnosed with diseases related to metabolism (gout, gallstones and urolithiasis, atherosclerosis, migraines), then the baby will most likely suffer from this syndrome. Proper nutrition also plays an important role.

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Acetonemic syndrome in children

Acetonemic syndrome in children usually has the following sequence: first, the child eats incorrectly, which leads to loss of appetite and frequent vomiting. At the same time, a distinct smell of acetone is felt from the baby's mouth. Vomiting often reoccurs after eating or drinking water. Sometimes leading to dehydration. As a rule, by the age of 10-11, acetonemic syndrome goes away on its own.

In addition to the fact that this disease is characterized by frequent crises, it is also possible to distinguish:

1. Insomnia, night terrors, increased sensitivity to smells, emotional lability, enuresis.
2. Poor nutrition occurs due to loss of appetite, abdominal pain that occurs periodically, pain in the joints and muscles, headache (migraine).
3. Dysmetabolic syndrome: when after a severe headache there is uncontrollable vomiting with a strong smell of acetone for one or two days.

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Acetonemic syndrome in adults

In adults, acetonemic syndrome can develop when the purine or protein balance is disturbed. In this case, the concentration of ketone bodies in the body increases. It is worth understanding that ketones are considered normal components of our body. They are the main source of energy. If the body receives a sufficient amount of carbohydrates, this helps prevent excessive production of acetone.

Adults often forget about proper nutrition, which leads to the accumulation of ketone compounds. This causes intoxication, which manifests itself as acetonemic vomiting.

In addition, the causes of acetonemic syndrome in adults may be:

1. Development of neuro-arthritic diathesis.
2. Constant stress.
3. Toxic and alimentary effects.
4. Renal failure.
5. Improper diet without sufficient carbohydrates.
6. Disorders of the endocrine system.
7. Fasting and diets.
8. Congenital pathologies.

Type 2 diabetes mellitus has a strong influence on the development of the disease.

Symptoms of the onset of acetonemic syndrome in adults:

1. The heart rate weakens.
2. The total amount of blood in the body is greatly reduced.
3. The skin is pale, with a bright blush appearing on the cheeks.
4. Cramping pains appear in the epigastric region.
5. Dehydration.
6. The amount of glucose in the blood decreases.
7. Nausea and vomiting.
8. Vomit appears in the urine.

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Complications and consequences

A large number of ketones, which lead to acetonemic syndrome, causes serious consequences. The most severe is metabolic acidosis, when the internal environment of the body becomes acidic. This can cause failures in the functioning of all organs. The child's breathing becomes more frequent, the blood flow to the lungs increases, while decreasing to other organs. In addition, ketones directly affect brain tissue, which can even cause a coma. A child with acetonemic syndrome is lethargic and inhibited.

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Diagnostics acetonemic syndrome

First of all, the doctor relies on the anamnesis data, analyzes the patient's complaints, looks at the clinical symptoms and conducts laboratory testing.

What criteria are used for diagnosis?

1. Episodes of vomiting are constantly recurring and very severe.
2. Between episodes there may be periods of calm of varying duration.
3. Vomiting can continue for days.
4. It is impossible to associate vomiting with gastrointestinal problems.
5. The vomiting attacks are stereotypical.
6. Sometimes vomiting ends very suddenly, without any treatment.
7. There are such accompanying symptoms: nausea, headache, abdominal pain, photophobia, lethargy, adynamia.
8. The patient is pale and may have fever and diarrhea.
9. Bile, blood, and mucus can be seen in the vomit.

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Tests

There are no changes in the clinical blood test. Usually, the picture shows only the pathology that led to the development of the syndrome.

A urine test is also taken, in which ketonuria can be seen (one plus or four pluses). However, the presence of glucose in the urine is not a special symptom.

Very important in making a diagnosis are the data obtained from the biochemical blood test. In this case, the longer the period of acetonemic vomiting, the better the dehydration is visible. The plasma shows a noticeable high hematocrit and protein level. The amount of urea in the blood also increases due to dehydration.

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Instrumental diagnostics

A very important method in establishing a diagnosis is echocardioscopy. With its help, it is possible to see the central hemodynamics indicators. The diastolic volume of the left ventricle is often reduced, venous pressure decreases, the ejection fraction also moderately decreases. Against this background, the cardiac index is increased due to tachycardia.

Differential diagnosis

As a rule, differential diagnostics is carried out with diabetic ketoacidosis. But the latter has the following features: hypoglycemia or significant hyperglycemia, there is no classic "diabetic" anamnesis, the patient's condition is noticeably better.

Treatment acetonemic syndrome

If you notice the first signs of acetonemic syndrome in your child, you should immediately give him any sorbent (this can be activated carbon or enterosgel). To prevent dehydration, you should constantly give mineral water to drink (can be replaced with unsweetened tea) in small quantities, but quite often (every 5-7 minutes). This will help reduce the urge to vomit.

In the treatment of acetonemic syndrome, the main methods are those aimed at combating crises. Supportive treatment is very important, which helps reduce exacerbations.

If the acetonemic crisis has already developed, the child is hospitalized. The so-called dietary correction is carried out immediately. It is based on the use of easily digestible carbohydrates, limiting fatty foods, providing fractional meals and drinking. Sometimes special cleansing enemas with sodium bicarbonate are given. It helps to eliminate some of the ketone bodies that have already entered the intestines. Oral rehydration is carried out using solutions such as rehydron or orsol.

If dehydration is severe, intravenous infusion of 5% glucose and saline solutions is necessary. Antispasmodics, sedatives, and antiemetics are often administered. With proper treatment, the symptoms of the syndrome subside within 2-5 days.

Medicines

• Activated carbon. A very popular sorbent. This carbon is of plant or animal origin. It is specially processed to increase its absorption activity. As a rule, it is prescribed at the beginning of an acetonemic crisis to remove toxins from the body. Among the main side effects, it is worth highlighting: constipation or diarrhea, depletion of proteins, vitamins and fats in the body.

Activated carbon is contraindicated in cases of gastric bleeding and stomach ulcers.

• Motilium. This is an antiemetic that blocks dopamine receptors. The active ingredient is domperidone. It is recommended to take the drug before meals. For children, the dosage is 1 tablet 3-4 times a day, for adults and children over 12 years old - 1-2 tablets 3-4 times a day.

Sometimes taking Motilium can cause the following side effects: intestinal spasms, intestinal disorders, extrapyramidal syndrome, headache, drowsiness, nervousness, increased prolactin levels in plasma.

The drug is not recommended for use in cases of prolactinoma, gastric bleeding, mechanical obstruction of the gastrointestinal tract, body weight up to 35 kg, individual intolerance to the components.

• Metoclopramide. A well-known antiemetic that helps relieve nausea, vomiting, and stimulate intestinal peristalsis. Adults are recommended to take up to 10 mg 3-4 times a day. Children over 6 years old can be given up to 5 mg 1-3 times a day.

Side effects from taking the drug include: diarrhea, constipation, dry mouth, headache, drowsiness, depression, dizziness, agranulocytosis, allergic reaction.

Do not take in case of gastric bleeding, gastric perforation, mechanical obstruction, epilepsy, pheochromocytoma, glaucoma, pregnancy, lactation.

• Thiamine. This drug is taken for vitamin deficiency and hypovitaminosis B1. It is often prescribed if the patient does not receive this vitamin well. It should not be taken if there is hypersensitivity to the components of the drug. Side effects include: Quincke's edema, itching, rash, urticaria.
• Atoxil. The drug helps to adsorb toxins in the gastrointestinal tract and remove them from the body. In addition, it removes harmful substances from the blood, skin and tissues. As a result, the body temperature decreases, vomiting stops. The drug is released in the form of a powder, from which a suspension is prepared. It should be taken one hour before meals or taking other drugs. Children from seven years old can take 12 g of the drug per day. The dosage for children under seven years old should be prescribed by a doctor.

Folk remedies

Acetonemic syndrome can be treated at home. But here it is worth paying attention to the fact that you can only use those means that can reduce acetone. If you do not see an improvement in the child's condition, you should immediately contact a doctor. In this case, folk remedies are suitable only to eliminate the unpleasant smell of acetone, reduce the temperature or relieve vomiting. For example, a decoction of sorrel or a special tea based on rose hips is perfect for eliminating the smell.

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Herbal treatment

Usually, herbal treatment is used to stop vomiting. For this purpose, the following decoctions are prepared:

1. Take 1 tablespoon of medicinal lemon balm and pour 1 glass of boiling water. Infuse for about an hour, wrapped in a warm cloth. Strain and drink 1 tablespoon up to six times a day.
2. Take 1 tablespoon of peppermint, pour a glass of boiling water. Infuse for two hours, then strain. Take up to 4 times a day, one tablespoon.
3. Take 1 tablespoon of lemon balm, thyme and catnip leaves and mix. Pour two glasses of boiling water and hold in a water bath for a while (15 minutes). Then cool. You need to drink everything in equal portions during the day. To improve the taste, you can add a slice of lemon.

Nutrition and diet for acetonemic syndrome

One of the main reasons for the appearance of acetonemic syndrome is poor nutrition. To avoid relapses of the disease in the future, it is necessary to strictly control your child's daily diet. Do not include foods with a high content of preservatives, carbonated drinks, chips. Do not give your baby too fatty or fried food.

In order for the treatment of acetonemic syndrome to be successful, it is necessary to follow a diet for two to three weeks. The diet menu must include: rice porridge, vegetable soups, mashed potatoes. If the symptoms do not return within a week, you can gradually add dietary meat (not fried), crackers, greens and vegetables.

The diet can always be adjusted if the symptoms of the syndrome return. If bad breath appears, you need to add a lot of water, which should be drunk in small portions.

On the first day of the diet, the child should not be given anything except rye bread croutons.

On the second day, you can add rice broth or diet baked apples.

If you do everything correctly, then on the third day the nausea and diarrhea will go away.

Do not stop the diet if the symptoms have gone away. Doctors recommend strictly adhering to all its rules. On the seventh day, you can add biscuits, rice porridge (without oil), and vegetable soup to your diet.

If the body temperature does not rise and the smell of acetone has disappeared, then the baby's diet can be made more varied. You can add lean fish, vegetable puree, buckwheat, and fermented milk products.

Prevention

After your child has recovered, it is necessary to carry out disease prevention. If this is not done, the acetonemic syndrome may become chronic. During the first days, be sure to follow a special diet, refuse fatty and spicy foods. After the diet is over, you need to gradually and very carefully introduce other products into the daily diet.

It is very important to eat healthy food. If you include all the necessary products in your child's diet, then nothing will threaten his health. Also try to provide him with an active lifestyle, avoid stress, strengthen the immune system and maintain microflora.

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Forecast

As a rule, the prognosis of this disease is favorable. Usually at the age of 11-12 years, acetonemic syndrome passes on its own, as do all its symptoms. If you seek qualified help from a specialist in a timely manner, this will help to avoid many complications and consequences.

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