Acetonemic syndrome

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

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

Causes of the acetone syndrome

Most acetonemic syndrome develops in children 12-13 years old. 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 acetone crisis. If such crises occur regularly, then we can talk about the disease.

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

[1], [2], [3]

Pathogenesis

The ways of catabolism of proteins, carbohydrates and fats under normal physiological conditions intersect at certain stages in the so-called Krebs cycle. It is a universal source of energy that allows the body to develop properly.

So, the carbohydrates that have passed the glycolytic path of Embden-Meyerhof transform into pyruvate (organic keto acid). He burns in the Krebs cycle. Proteins, in turn, are cleaved by proteases for amino acids (alanine, cysteine and serine also convert to pyruvate, tyrosine, aspartic acid and phenylalanine are sources of pyruvate or oxaloacetate, tyrosine, phenylalanine and leucine are converted to acetyl Coenzyme A). Fats with the help of lipolysis also turn into acetyl-coenzyme A.

When fasting or excessive consumption of protein and fatty foods, constant stress develops ketosis. If the body, at the same time, feels a relative or absolute deficiency of carbohydrates, then stimulates lipolysis, which must satisfy the need for energy.

With increased lipolysis, a large number of free fatty acids enter the liver. When they get there, they begin to transform into acetyl-Coenzyme A. In this case, the intake of Krebs is limited by the decrease in the amount of oxaloacetate (due to the insufficiency of carbohydrates). The activity of enzymes starts 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, the gastrointestinal tract, and the lungs. That is, acetonemic syndrome begins to develop if the rate of utilization of ketone bodies is lower than the rate of their synthesis.

[4], [5], [6]

Symptoms of the acetone syndrome

Usually, children who suffer from acetaminic syndrome have a lean physique, they often suffer from insomnia and neuroses. Sometimes they are very shy, their nervous system is quickly depleted. Despite this, such children develop speech, memory, cognitive processes better than those of other peers.

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

In a typical acetoneemic syndrome, a frequent symptom is severe nausea with vomiting, after which signs of intoxication or dehydration appear. Usually, after motor anxiety and excitability, the child experiences a period of drowsiness and lethargy. If the disease passes in severe form, cramps, abdominal cramps, diarrhea or constipation, fever may occur.

[7], [8], [9]

First signs

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

[10], [11]

Acetonemic vomiting syndrome

Syndrome acetonemic vomiting is a concomitant syndrome in neuro-arthritic diathesis. This disease is considered a special feature of the device of the child's organism. It is characterized by the fact that the mineral and purine metabolism is changing. A similar condition is diagnosed in 3-5% of children. At what, in recent years the number of patients is constantly increasing.

The main symptoms of acetonemic vomiting syndrome are:

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

Here a very important role is played by heredity. If the relatives of the child have been diagnosed with diseases associated with the metabolism (gout, cholelithiasis and urolithiasis, atherosclerosis, migraines), then it is more likely that the baby will be ill on this syndrome. Proper nutrition is also important.

[12], [13]

Acetonemic syndrome in children

Acetonemic syndrome in children, as a rule, has this sequence: first the child is malnourished, which leads to loss of appetite, frequent vomiting. At the same time, from the baby's mouth, there is a distinct smell of acetone. Vomiting is often repeated after eating food or water. Sometimes leading to dehydration. As a rule, by the age of 10-11 the acetonemic syndrome passes independently.

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

1. Insomnia, night fears, increased sensitivity to smells, emotional lability, enuresis.
2. Poor nutrition occurs due to loss of appetite, pain in the abdomen, which occur periodically, joint and muscle pain, headache (migraine).
3. Dysmetabolic syndrome: when after a severe headache one or two days there is an uncontrollable vomiting with a strong smell of acetone.

[14], [15]

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 increases in the body. It should be understood that ketones are considered normal components of our body. They are the main source of energy. If the body receives enough carbohydrates, then this prevents excessive production of acetone.

Adults often forget about proper nutrition, which leads to the fact that ketone compounds begin to accumulate. This is the cause of intoxication, which manifests itself by acetone-making vomiting.

In addition, the causes of acetone syndrome in adults can be:

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

Strongly affects the development of the disease type 2 diabetes.

Symptoms of the onset of acetone syndrome in adults:

1. Heart rhythm weakens.
2. The total amount of blood in the body is greatly reduced.
3. The skin is pale, there is a bright blush on the cheeks.
4. In the epigastric region there are cramping pains.
5. Dehydration.
6. The amount of glucose in the blood goes down.
7. Nausea and vomiting.
8. Vomit appears in the urine.

[16], [17], [18]

Complications and consequences

A large number of ketones, which lead to acetone syndrome, causes serious consequences. The most severe is metabolic acidosis, when the internal environment of the body is acidified. This can cause malfunctioning of all organs. The child breathes faster, the flow of blood to the lungs increases, while decreasing to other organs. In addition, ketones directly act on the brain tissue, which can cause even to whom. The child with acetone syndrome is sluggish and inhibited.

[19], [20]

Diagnostics of the acetone syndrome

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

What are the criteria used in the diagnosis?

1. Episodes of vomiting are constantly repeated and are very strong.
2. Between the episodes there can be periods of tranquility with different duration.
3. Vomiting can last for days.
4. It is impossible to associate vomiting with abnormalities in the work of the digestive tract.
5. Vomiting attacks are stereotyped.
6. Sometimes vomiting ends very suddenly, without any treatment.
7. There are such accompanying symptoms: nausea, headache, abdominal pain, photophobia, inhibition, adynamia.
8. The patient is pale, he may have fever, diarrhea.
9. In vomit masses you can see bile, blood, mucus.

[21], [22]

Analyzes

With a clinical analysis of the blood, there are no changes. Usually the picture shows only the pathology that led to the development of the syndrome.

There is also an analysis of urine, in which you can see ketonuria (one plus or four plus). However, the presence of glucose in urine is not a special symptom.

Very important when determining the diagnosis are the data obtained from a biochemical blood test. In this case, the longer the length of the acetone vomiting period, the better the dehydration is visible. Plasma has a noticeable high index of hematocrit and protein. The blood also increases the amount of urea due to dehydration.

[23],

Instrumental diagnostics

A very important method in the diagnosis is echocardioscopy. With its help you can see the indices of central hemodynamics. The diastolic volume of the left ventricle is often reduced, the venous pressure decreases, and the ejection fraction also moderately decreases. Against the background of all this, the cardiac index is increased because of tachycardia.

Differential diagnosis

As a rule, differential diagnosis is performed with diabetic ketoacidosis. But the features of the latter are: hypoglycemia or significant hyperglycemia, there is no classic "diabetic" anamnesis, the patient's condition is noticeably better.

Treatment of the acetone syndrome

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

In the treatment of acetone syndrome, the main methods are those that are aimed at combating crises. It is very important maintenance treatment, which helps to reduce exacerbations.

If the acetone crisis has already developed, the child is hospitalized. Immediately carry out the so-called dietary correction. It is based on the use of easily assimilated carbohydrates, limiting fatty foods, providing fractional nutrition and drinking. Sometimes put a special cleansing enema with sodium bicarbonate. It helps to eliminate some of the ketone bodies that have already entered the intestine. Oral rehydration with the help of such solutions as rehydron or orsol.

If dehydration is strongly pronounced, an intravenous infusion of 5% glucose and saline solutions should be performed. Often inject antispasmodics, sedatives and antiemetics. With proper treatment, the symptoms of the syndrome die out after 2-5 days.

Medications

• Activated carbon. Sorbent, which is very popular. This coal is of vegetable or animal origin. It is specially treated to increase its absorbent activity. As a rule, it is prescribed at the beginning of the acetone crisis to remove toxins from the body. Among the main side effects are: constipation or diarrhea, impoverishment of the body with proteins, vitamins and fats.

Activated charcoal is contraindicated in gastric bleeding, stomach ulcers.

• Motilium. It is an anti-emetic that blocks dopamine receptors. Active active substance is domperidone. It is recommended to take the drug before eating. For children, the dosage is 1 tablet 3-4 times a day, for adults and children over 12 years - 1-2 tablets 3-4 times a day.

Sometimes, Motilium may cause such side effects: intestinal cramps, intestinal disorders, extrapyramidal syndrome, headache, drowsiness, nervousness, plasma prolactin levels increase.

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

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

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

It can not be taken with bleeding in the stomach, perforation of the stomach, mechanical obstruction, epilepsy, pheochromocytoma, glaucoma, pregnancy, lactation.

• Thiamine. This drug is taken with avitaminosis and hypovitaminosis B1. Often, it is prescribed in the event that the patient does not receive this vitamin in the body. Do not take if hypersensitivity to the components of the drug. Side effects are: Quincke's edema, itching, rash, hives.
• Atoxyl. The drug helps adsorb toxins in the digestive tract and remove them from the body. In addition, it removes harmful substances from the blood, skin and tissues. As a result, body temperature decreases, vomiting stops. The preparation is in the form of a powder from which a suspension is prepared. Take one hour before meals or taking other medications. Children from seven years can consume 12 g of the drug per day. Dosage for children under seven years of age should be prescribed by a doctor.

Alternative treatment

Acetonemic syndrome can be treated at home. But here you should pay attention to the fact that you can use only those tools that can bring down acetone. If you do not see an improvement in the child's condition, you should immediately consult a doctor. Alternative treatment in this case is suitable only to eliminate the unpleasant odor of acetone, reduce the temperature or remove vomiting. For example, to remove the smell is perfect for a decoction of sorrel or a special tea based on dog rose.

[24], [25], [26], [27], [28], [29], [30]

Herbal Treatment

Usually, herbs are treated to stop vomiting. For this, such broths are prepared:

1. Take 1 tablespoon of medicinal melissa and pour 1 cup of boiling water. Insist 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. They insist for two hours, then they plant. Take up to 4 times a day for one tablespoon.
3. Take 1 tablespoon of the leaves of the medicinal melissa, thyme and cats, mixed. Pour two cups of boiling water and hold it for a while in a water bath (15 minutes). Then cool. For a day you need to drink everything in equal portions. To improve the taste, you can add a lemon slice.

Nutrition and diet for acetone syndrome

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

To treat acetone syndrome was successful, you must follow a diet of two to three weeks. The diet menu necessarily includes: 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 again. If bad breath comes in, you need to add a lot of water, which must be drunk in small portions.

On the first day of the diet, you can not give the child anything, except rusk bread rusks.

On the second day you can add rice decoction or dietary baked apples.

If everything is done correctly, then on the third day, nausea and diarrhea will pass.

In no case do not complete the diet if the symptoms are gone. Doctors recommend strictly adhere to all of its rules. On the seventh day, you can add to the diet galette cookies, rice porridge (without butter), vegetable soup.

If the body temperature does not increase, and the smell of acetone is gone, then the baby's nutrition can be made more diverse. You can add low-fat fish, vegetable puree, buckwheat, sour-milk products.

Prevention

After your child has recovered, it is necessary to prevent the disease. If this is not done, that the acetone syndrome can become chronic. First days, be sure to observe a special diet, give up fatty and spicy food. After the diet is over, you need to gradually and very carefully enter into the daily diet of other foods.

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

[31], [32], [33], [34]

Forecast

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

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