A Case Report of Idiopathic Ketotic Hypoglycemia Masquerading as Epilepsy

Abstract

Idiopathic ketotic hypoglycemia (IKH) is characterized by recurrent neurohypoglycemic symptoms with ketosis. Hypoglycemic episodes typically occur during early mornings, especially either with illness and/or prolonged fasting. We reported a case of IKH which presented with recurrent episodes of seizures during early morning with intercurrent illness and which was labeled as epilepsy and started on antiepileptic medication. The purpose of this case report is to alert clinicians about this condition, which is not an uncommon entity, but rarely thought of. Therefore, in view of keeping the IKH in mind, which can be prevented with proper diet advice during illness, unnecessary long-term antiepileptic therapy can be avoided.

Keywords

idiopathic ketotic hypoglycemia - epilepsy - diet advice

Authors' Contributions

S.C.D. took part in case management, follow-up, and drafted the manuscript; K.C. contributed in case management; P.M. contributed in literature review and designed the manuscript; L.K.C. performed the literature review and reviewed the manuscript.

• References

• 1 Stanton BF, St Geme III JW, Schor NF. Sperling Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2015: 773-788
• 2 Huidekoper HH, Duran M, Turkenburg M, Ackermans MT, Sauerwein HP, Wijburg FA. Fasting adaptation in idiopathic ketotic hypoglycemia: a mismatch between glucose production and demand. Eur J Pediatr 2008; 167 (08) 859-865
• 3 Bodamer OA, Hussein K, Morris AA. , et al. Glucose and leucine kinetics in idiopathic ketotic hypoglycaemia. Arch Dis Child 2006; 91 (06) 483-486
• 4 Haymond MW, Karl IE, Pagliara AS. Ketotic hypoglycemia: an amino acid substrate limited disorder. J Clin Endocrinol Metab 1974; 38 (04) 521-530
• 5 Haymond MW, Howard C, Ben-Galim E, DeVivo DC. Effects of ketosis on glucose flux in children and adults. Am J Physiol 1983; 245 (04) E373-E378
• 6 Bier DM, Leake RD, Haymond MW. , et al. Measurement of “true” glucose production rates in infancy and childhood with 6,6-dideuteroglucose. Diabetes 1977; 26 (11) 1016-1023
• 7 Thomas M, Jacob JJ, Alexander P. Idiopathic ketotic hypoglycemia presenting as febrile seizures. Indian J Pediatr 2010; 77 (12) 1448-1449
• 8 Daly LP, Osterhoudt KC, Weinzimer SA. Presenting features of idiopathic ketotic hypoglycemia. J Emerg Med 2003; 25 (01) 39-43
• 9 Kogut MD, Blaskovics M, Donnell GN. Idiopathic hypoglycemia: a study of twenty-six children. J Pediatr 1969; 74 (06) 853-871
• 10 Yadav S, Nigwekar P, Shrikhande DY, Patil A, Yadav A, Maniya N. Ketotic hypoglycemia in children “not an uncommon entity but is rarely thought of”: case series. Int J Med Res Health Sci 2013; 2 (04) 1009-1012