Ketotic hypoglycemia is a common type of low blood sugar in young children without diabetes. It involves blood sugar less than 70 mg/dL with ketones. It’s often linked to fasting, illness, or dehydration. Sugar is the best treatment.

Ketotic hypoglycemia is a common type of low blood sugar that occurs mostly in children without diabetes who are between 6 months and 6 years old.

It can cause sluggishness, dizziness, irritability, and other symptoms. As with all types of hypoglycemia, the treatment involves boosting their blood sugar with glucose (sugar). Children usually grow out of this condition.

This article will explain ketotic hypoglycemia, including its causes, symptoms, and risks and the treatments you can discuss with your healthcare team.

Ketotic hypoglycemia is an episode of low blood sugar involving the presence of ketones in the urine or blood.

It is the most common type of low blood sugar in toddlers and young children without diabetes. Low blood sugar is any level lower than 70 milligrams per deciliter (mg/dL).

Ketones develop in your body when cells are not receiving glucose for energy and your body starts to burn fat for fuel instead. The resulting ketones are chemicals that cause your blood to become acidic, which can be dangerous.

Usually, ketotic hypoglycemia occurs after a prolonged period of not eating, typically during a fast or illness.

Yes. While both low blood sugar levels and ketones in the blood or urine are common in people with diabetes, people without diabetes may also experience low blood sugar and ketones at the same time, especially if they have been fasting or are sick.

Children — the population most affected by this condition — can develop ketotic hypoglycemia after 6–12 hours of fasting. The condition can be worse if they are dehydrated due to diarrhea or vomiting.

Most children will outgrow this condition by the time they’re 6 years old, and it usually does not cause any permanent harm.

The exact cause of ketotic hypoglycemia is unknown, but many factors can contribute to the development of the condition.

The primary contributing factor is decreased oral intake or a period of fasting with vomiting due to gastrointestinal distress or illness.

Periods of extremely low carbohydrate intake due to a ketogenic diet, disordered eating, or picky eating may also cause this condition, especially in the presence of dehydration, which can promote the development of ketones.

There are two theories as to why some children may develop ketotic hypoglycemia while others may not:

  1. Young children who develop this condition tend to use up the stored energy from their liver and switch to making ketones for energy more quickly than other children.
  2. These children’s bodies sometimes cannot use stored fat and muscle for energy to regulate their blood sugar.

Most children will outgrow these occurrences as their bodies adapt to storing and using fuel sources such as carbohydrates and fats more appropriately.

Yes, this condition primarily affects children 6 years old or younger.

In rare cases, adults can experience ketotic hypoglycemia due to extremely low carbohydrate diets, intermittent fasting, or disordered eating combined with dehydration and alcohol intake.

The most common symptoms of ketotic hypoglycemia are:

  • dizziness
  • fruity-smelling breath (the smell of ketones)
  • sluggishness
  • shakiness
  • sweating
  • rapid heart rate
  • tiredness
  • hunger
  • irritability
  • headache
  • pale skin (pallor)
  • unexplainable tantrums or crying
  • clumsiness
  • confusion
  • seizures

However, each person may experience symptoms differently.

Ketotic hypoglycemia can be extremely dangerous if a child’s blood sugar does not come up, especially if they cannot hold down any food or liquid due to vomiting.

This can become a medical emergency. If you suspect that your child has low blood sugar, try to give them sugar as soon as possible.

Although rare in children without diabetes, severely low blood sugar levels can lead to coma and become deadly if not properly treated.

While the condition can become dangerous, the treatment is very simple.

Giving the child any form of sugar should adequately bring up their blood sugar levels. Examples include juice and other foods and drinks containing sugar.

The child’s blood sugar should increase within 15–20 minutes of consuming the sugar.

If their blood sugar has not risen after 20 minutes or they cannot eat or drink due to vomiting, sluggishness, or seizures, seek emergency medical treatment so that they can receive IV fluids containing glucose.

Treatment is the same for adults. However, since the condition is rare in adults, doctors may require further testing to rule out any underlying issues.

Ketotic hypoglycemia is the most common type of low blood sugar in toddlers and young children without diabetes. It is defined as a blood sugar level of less than 70 mg/dL with the presence of ketones. It usually occurs after long periods of fasting or during an illness, as a result of dehydration.

Children usually grow out of ketotic hypoglycemia by age 6 years. Symptoms of ketotic hypoglycemia include sluggishness, dizziness, shakiness, fruity-smelling breath, tiredness, and irritability.

The treatment for ketotic hypoglycemia is to give the child sugar. If your child cannot eat or drink and they’re showing symptoms of ketotic hypoglycemia, seek emergency medical attention immediately. A doctor can rule out underlying conditions and assess the seriousness of any hypoglycemic episodes.