The smell of acetone from the mouth of the child

When parents feel the smell of acetone from the mouth of a child, the question arises: what are the reasons? Do not hesitate to apply for medical help: this symptom is a signal of disruption of the endocrine system of the child's body and the development of serious pathologies of metabolism.

Causes of the odor of acetone from the mouth in the child

The main reasons are connected with the problems of the metabolism of fats and carbohydrates - ketosis (ketogenesis) and catabolism of ketone bodies. When, due to a lack of insulin, the body lacks glucose to generate energy, the accumulation of fats begins (which in the form of triglycerides are found in adipose tissue cells). This biochemical process takes place with the formation of by-products - ketone bodies (ketones). In addition, with insulin deficiency, the utilization of ketones in muscle cells decreases, which also increases their content in the body. Excess ketone bodies are toxic to the body and lead to ketoacidosis with the odor of acetone upon exhalation, which can be:

• at a diabetes of the first type (insulin-dependent, having an autoimmune etiology);
• with congenital syndromes accompanied by insulin deficiency and a violation of carbohydrate metabolism (including Lawrence-Moon-Barde-Biddle, Wolfram, Morgani-Morel-Stewart, Prader-Willy, Klinefelter, Lynch-Kaplan-Henna, Mc Quarry) syndromes;
• in the case of functional kidney failure (in particular, with a decrease in glomerular filtration rate);
• with a deficiency of certain liver enzymes;
• with pronounced impairment of the functions of the pancreas and adrenal glands of the child;
• at a high level of thyroid hormones, caused by hyperthyroidism (including pituitary).

[1], [2]

Risk factors

Mark such risk factors for the appearance of acetone odor, as infectious diseases with a significant temperature increase, persistent infections, helminthic invasion, stressful conditions.

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

It should be borne in mind that the frequent use of corticosteroids (negatively affecting the adrenal cortex) and antiviral agents containing recombinant interferon alfa-2b may trigger the development of autoimmune diabetes in children.

[3], [4]

Pathogenesis

The presence of the odor of acetone from the mouth in a child or adolescent is indicative of acetonemia (hyperacetonemia) - an excess of ketones in the blood. Oxidizing, they lower 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 a lack of insulin and hypoglycemia, which leads to increased lipolysis - the cleavage of triglycerides into fatty acids and transport them to the liver. In hepatocytes they are oxidized with the formation of acetyl-coenzyme A (acetyl-CoA), and from its surplus ketones are formed - acetoacetic acid and β-hydroxybutyrate. The liver does not cope with the treatment of so many ketones, and their level in the blood increases. Further, acetoacetic acid is decarboxylated 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, there is a smell of acetone from the mouth.

Cell and membrane enzymes (CoA transferase, acyl-CoA dehydrogenase, β-thioketolase, carnitine, carnitine acyltransferase, etc.) are required to oxidize fatty acids, and their genetically determined deficiency in congenital syndromes is the leading cause of ketone metabolism disorders. In some cases, the mutations of the gene of the hepatic enzyme phosphorylase located on the X chromosome are responsible, leading to a deficiency or a decrease in activity. In children aged one to five years, the presence of a mutant gene is manifested as a smell of acetone from the mouth, as well as growth retardation and hepatomegaly (increase in the liver). Over time, liver size normalizes, the child in most cases begins to catch up with peers on growth, but the liver can form fibrous septa and there are signs of inflammation.

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

And with an excess of fat in the food consumed by children, the transformation of fatty acids into fatty acid triglycerides in the fat cells is hampered, why some of them appear in mitochondria of liver cells where they are oxidized with the formation of ketones.

Symptoms of the odor of acetone from the mouth in the child

In ketoacidosis and hyperacetonemia in a child such a smell is by no means the only symptom.

If there is a slight odor of acetone from the mouth of the child, then there may be increased thirst and drying of the mucous in the oral cavity. Probably, the child has tonsillitis or acute respiratory viral infection with an increase in temperature, or he has run too much or is overexcited. However, one should not forget that this smell and thirst are the first signs of the development of insulin-dependent diabetes and the mild form of diabetic ketoacidosis.

As endocrinologists note, metabolic disorders in childhood can lead to acetone syndrome, when the child has a mouthache of acetone and vomiting, as well as general weakness, decreased appetite, reduced diuresis, nausea, abdominal and headaches. More information on the etiology and symptoms can be found 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 blood plasma and urine, small hyperthermia, shallow breathing and rapid heartbeat - is called acetone crisis. Its main danger is the  dehydration of the  child's body , since the attacks of vomiting multiple throughout the day and can last not one day.

Complications and consequences

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

Also, cerebral edema is possible (about 1% of cases), acute ischemic or hemorrhagic stroke, pulmonary interstitial edema and coagulopathies (due to the violation of coagulation factors).

In addition, as with any increase in the acidity of the blood, the endothelium of the blood vessels may suffer: supersaturation of blood with ketone bodies increases the negative impact of free radicals on cells and leads to oxidative stress. It is believed that ketones, more precisely, their elevated level, are related to the oncolopathology.

In the acetone syndrome, there is a possibility of an increase in the liver and its fatty infiltration, and in severe acetone crises, the risk of coma and death can not be ruled out.

Diagnostics of the odor of acetone from the mouth in the child

If there is a smell of acetone from the mouth of the child, the diagnosis is designed to reveal its cause. For this, analyzes are necessary:

• general clinical tests of blood, urine and feces;
• a blood and urine test for glucose.
• blood test for pH, for the content of β-hydroxybutyrate, electrolytes, phosphates, creatinine;
• urine analysis to the level of dimethyl ketone.

The diagnosis is confirmed by the presence of a high level of glucose in the blood along with abnormal ketones and acidosis of the blood. As a rule, depletion of potassium, bicarbonate and phosphate is revealed.

Also see the material -  Diagnosis of diabetes mellitus

A blood test is performed on the level of thyroid hormones (T3, T4 and TTG) and the presence of antibodies to them. Instrumental diagnostics with suspicion of hyperthyroidism is performed with the help of an X-ray or ultrasound (ultrasound) of the thyroid gland. It may be necessary to conduct an instrumental examination of the pancreas, liver and kidneys.

Differential diagnosis

Differential diagnosis is performed with hyperammonemia and hyperosmolar hyperglycemia (complication of diabetes); Ascenemic vomiting should be differentiated from vomiting in other diseases, including infectious ones.

Treatment of the odor of acetone from the mouth in the child

Treatment of the odor of acetone from the mouth in a child consists in the treatment of diseases in which this odor appears. With diabetes, a child needs insulin, see -  Treatment of diabetes mellitus

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

With hyperketonemia and ketoacidosis, foods containing fats should be excluded from the diet of the child: this will reduce the intake of fatty acids and greatly facilitate the work of the liver.

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

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

For rehydration - compensation of fluid during vomiting - use Regidron, as well as alkaline mineral water (without gas) at the rate of 100-120 ml of fluid for each kilogram of the body weight of the child. More information in the material -  Vomiting in the child

Conducting a folk treatment of hyperacetonemia is unsafe, especially since the cause of the smell of acetone is not eliminated. But the advice to give the child a cranberry fruit drink, a decoction of dried apricots or quince, and also green tea with the addition of lemon - you can take it to fill the liquid with vomit. A herbal treatment allows you to use for nausea and vomiting broths of chamomile flowers, herbaceous grass, chicory root or angelica officinalis - two or three tablespoons several times during the day.

Prevention

Is it possible to prevent the appearance of the odor of acetone from the mouth in the 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 blood sugar level of the baby, and also drink enough fluids. If a child has diabetes, then you must adhere to certain dietary rules, and for this there is a  diet for type 1 diabetes

[5], [6]

Forecast

Exact forecast specialists give only in relation to acetone syndrome in children: as a rule, with full age, complete recovery is noted. In very rare cases of acetone crisis, paralysis of respiration and cardiac arrest may result in death.

[7], [8], [9]