Idiopathic Ketotic Hypoglycemia (IKH)

Idiopathic Ketotic Hypoglycemia (IKH), also known as ‘accelerated starvation’ is the common cause of clinically significant non-diabetic hypoglycemia among children between 1 and 5 years of age.[1] Originally described by Colle and Ulstrom in 1964, IKH is defined by periodic episodes of hypoglycemia, associated with ketonuria, in an otherwise healthy child, usually occurring after food deprivation.[2] The hypoglycemia is associated with raised ketone bodies and free fatty acids with suppressed insulin levels.[3] The most likely cause is an imbalance in the suppression of glucose utilization by ketone bodies and a limited rate of hepatic glucose production.[4] Diagnosis requires exclusion of other causes of hypoglycemia, particularly GH deficiency, hypopituitarism, adrenocorticotropic hormone (ACTH) unresponsiveness, and glycogen synthase deficiency, all of which may have similar presentations. Here we report a child presented to us for dental extractions under general anaesthesia.
An eight-year-old boy, weighing 35 kg, known case of IKH for past 5 years and asthma since childhood, was
1b) and his blood glucose was monitored every 4 hourly along with urinary ketones and lactic acid once nothing per oral (NPO). The relevant investigations were Hb - 2.7 g/dl, Hct - 40.2%, Na - 139 mmol/l, K - 5.3 mmol/l, Bicarbonate - 25.6mmol/l, glucose – 95 g/dl and lactic acid - 4.8 mmol/l. As fasting for surgery and anaesthesia is inevitable, every effort was made in planning and scheduling to perform surgical procedure right after six hours of