{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T19:31:44Z","timestamp":1790278304535,"version":"4.1.0"},"reference-count":24,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Pediatr Emer Care"],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:sec>\n            <jats:title>Objectives<\/jats:title>\n            <jats:p>Starvation ketosis may occur in children during intercurrent illnesses due to metabolic adaptation to fasting, resulting in significant ketonemia and sometimes ketoacidosis. Also known as accelerated starvation, common symptoms are vomiting, lethargy, and seizures. Previous studies found the prevalence of ketotic hypoglycemia to be 4 per 100,000 presentations to the emergency department (ED). We hypothesized that the prevalence had been underestimated due to the retrospective nature and restricted definitions of previous studies. Our aim was to determine if a prospective study would confirm a higher prevalence of starvation ketosis in pediatric patients presenting to the ED.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>A prospective observational study of consecutive patients was performed in an urban pediatric ED utilizing point-of-care testing of capillary blood glucose and ketones in symptomatic children.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>This study found the prevalence of clinically significant ketosis (defined as beta-hydroxybutyrate 2.5 mmol\/L or more) to be approximately 1800 per 100,000 ED presentations, with more than 170 per 100,000 also being hypoglycemic. Affected patients were 3 months to 9 years of age. Fifty-five percent of the presentations were boys, and 56% were under the 50th centile for weight.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>This prospective observational study using a targeted testing regimen found the prevalence of both starvation ketosis and hypoglycemia to be much greater than previous studies which used retrospective analyses. A simple capillary test for ketones should be considered in unwell children younger than 10 years who present with vomiting or lethargy, as this may identify the need for specific therapy to resolve ketosis.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/pec.0000000000002188","type":"journal-article","created":{"date-parts":[[2020,7,13]],"date-time":"2020-07-13T06:00:08Z","timestamp":1594620008000},"page":"e147-e150","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":13,"title":["Starvation Ketosis in the Pediatric Emergency Department"],"prefix":"10.1097","volume":"38","author":[{"given":"Robert","family":"Millar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amelia","family":"Chiappazzo","sequence":"additional","affiliation":[{"name":"University of Melbourne, Faculty of Medicine, Dentistry & Health Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bethany","family":"Palmer","sequence":"additional","affiliation":[{"name":"University of Melbourne, Faculty of Medicine, Dentistry & Health Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2020,7,8]]},"reference":[{"key":"bib1-20250504","first-page":"549","article-title":"Non-diabetic ketosis in children","volume":"34","year":"1927","journal-title":"Am J Dis Child"},{"key":"bib2-20250504","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1136\/pgmj.51.600.737","article-title":"Ketotic hypoglycaemia of childhood","volume":"51","year":"1975","journal-title":"Postgrad Med J"},{"key":"bib3-20250504","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1016\/S0022-3476(64)80611-9","article-title":"Ketotic hypoglycemia","volume":"64","year":"1964","journal-title":"J Pediatr"},{"key":"bib4-20250504","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1002\/pdi.1769","article-title":"Euglycaemic ketoacidosis in patients with and without diabetes","volume":"30","year":"2013","journal-title":"Practical Diabetes"},{"key":"bib5-20250504","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1111\/1742-6723.13276","article-title":"Review article: accelerated starvation of childhood: have I judged ketones?","volume":"31","year":"2019","journal-title":"Emerg Med Australas"},{"key":"bib6-20250504","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1136\/adc.46.247.295","article-title":"Diagnosis of ketotic hypoglycaemia of childhood","volume":"46","year":"1971","journal-title":"Arch Dis Child"},{"key":"bib7-20250504","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/S0736-4679(03)00100-8","article-title":"Presenting features of idiopathic ketotic hypoglycemia","volume":"25","year":"2003","journal-title":"J Emerg Med"},{"key":"bib8-20250504","first-page":"169","article-title":"Fasting as a cause for convulsions","volume":"31","year":"1926","journal-title":"Am J Dis Child"},{"key":"bib9-20250504","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1097\/EJA.0000000000000330","article-title":"Impact of preoperative fasting times on blood glucose concentration, ketone bodies and acid-base balance in children younger than 36 months: a prospective observational study","volume":"32","year":"2015","journal-title":"Eur J Anaesthesiol"},{"key":"bib10-20250504","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1097\/00006565-199808000-00006","article-title":"Childhood hypoglycemia in an urban emergency department: epidemiology and a diagnostic approach to the problem","volume":"14","year":"1998","journal-title":"Pediatr Emerg Care"},{"key":"bib11-20250504","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1016\/S0022-3476(73)80152-0","article-title":"Ketotic hypoglycemia. 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