# Is sweet-smelling breath a good sign, you think? - Urgent! Help! Update #10



## leila1213 (Sep 15, 2006)

We don't generally brush DD's teeth very often, but her breath always smells good to me...you know how EBF babies' breath does? Kind of like that but not exactly. She is BF, of course, but she also has some issues that make me worry she's not getting the right nutrition. So I guess I'm grasping at straws hoping that this means she is healthy. Or maybe it's a bad sign. Isn't there some condition that gives you sweet-smelling breath? Ketoacidosis? Am I making this up? I think I need to go to bed...


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## purplepaisleymama (Jan 31, 2007)

Your memory isn't going, that is a sign of ketoacidosis and of early diabetes. It can also be a sign of metabolic issues and of allergies, though I don't know which ones. I just posted a response to another similar question, I would post on the special needs forum, sometimes moms there are familiar with the different reasons these things happen.
Hope that you get an answer soon,
laura


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## txtarheel (May 27, 2006)

I'm sure there are other reasons as well, but since I've had type 1 for 20+ years, ketoacidosis was my first thought.


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## leila1213 (Sep 15, 2006)

Oh great. So what exactly does that mean? I guess I need to find a good holistic practitioner to help, because I'm obviously not having success on my own. Would a naturopath be a good choice?


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## sbgrace (Sep 22, 2004)

If you suspect she might have diabetes I would go to someone who will run the labs to check for diabetes. Did your daughter have a newborn screening for metabolic conditions?

What types of issues does your daughter have? Could you be seeing signs of a metabolic condition?

It's hard to find a doctor knowledgable about metabolics. I think you need to check for diabetes. If that isn't it, I think you need an expanded newborn screen if your daughter didn't have one (and/or a metabolic work up if it is too late for a newborn screen).

I'm particularly concerned because it sounds like you're already seeing signs that are bothering you about her health?


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## leila1213 (Sep 15, 2006)

You know what's ironic? She had a blood draw for lead and CBC, and the nurse asked if I wanted to test for anything else, while we were at it. I asked "like what?" And she suggested diabetes. I thought that sounded totally crazy and was like "oh no, we don't need that!"

Other symptoms: Constipation is the main one, but I've seen some little eczema-like rashes once in a blue moon. Lately her skin has had this funny dry texture to it, almost like tiny little bumps that you can't even see. She's also been reeeeeeally hard to put to sleep lately, but her recent difficulties have coincided with our last move, so I just thought it was stress.

I just looked at the symptoms of type 1 and ketoacidosis, and I don't see anything familiar except the sweet-smelling breath. She did have a cough about a month ago that took awhile to go away, and she had a couple of coughing spells after exertion, but it went away and didn't seem serious. She does have a heart murmur that our last doc didn't think was anything to be concerned about.

She's had slightly elevated lead levels that we've never really resolved, but we have moved since then. I had a hair test done that was so crazy off the charts that the only way I could reconcile it was that I did the test wrong and it was tainted.

She had all the normal newborn screenings.

I'll call her old docs on Monday and see if I can get any info and have her chart sent to me. We don't have a doc here in Richmond yet.

What else would I be looking for for a metabolic condition? What are the names of some I could look up?

What should I be feeding her to keep her well at this point? She needs very frequent meals??

I just thought of another symptom that might be relevant. She loves sweets. I feel silly typing that, because, who doesn't? I've always been careful of not giving her sugar, but I think I made the mistake of feeding her basically unlimited amounts of fruit from the time she started solids. Since realizing that she needed a lot more fat and protein to help her constipation, I started to limit fiber, bread, etc. But lately I feel like my DH has been sabotaging my efforts by offering her a lot more fruit, dried fruit, and sweets/baked goods/frozen waffles than I would ever give her in a million years. We've also been eating a lot of french toast for breakfast (with maple syrup) and rice noodles for lunch or dinner. Bananas and dried fruit are her favorite snacks.

Oh, and she's "only" had her 2 month shots.


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## leila1213 (Sep 15, 2006)

Can I get urine test strips at the drug store?


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## leila1213 (Sep 15, 2006)

I got some urine test strips for ketones. Is this what I want? Should I go ahead?


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## leila1213 (Sep 15, 2006)

So, we did the urine ketone test. Hers came out between negative and trace, exactly the same as mine.







: Any thoughts on what to do next?


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## leila1213 (Sep 15, 2006)

DD has been saying today that her tummy hurts, and hasn't wanted to eat anything all day. She's BFing frequently, but I noticed the "nail polish remover/acetone" smell on her breath that I read about somewhere. I had her pee on another ketone tester, and it is in the moderate to high range!!! Ack!!! What do I do???


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## leila1213 (Sep 15, 2006)

Another question I just thought of: the test also talks about how you can use it if you are on a low-carb diet to see if you are in ketosis. What is the difference between ketosis and ketoacidosis? Is it possible she just hasn't had a lot of carbs lately and that has put her into ketosis? What is the danger of that?


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## lindberg99 (Apr 23, 2003)

I think you should take her to a doctor and have her blood sugar tested.

My DH has been type 1 diabetic for a long time now so I have some knowledge of it from him. The urine strips are not as reliable as a blood sugar. They might be able to do a quick test with a finger prick and a blood sugar meter.

How old is she?

Let us know what happens!!


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## leila1213 (Sep 15, 2006)

She's 2.5. Thanks!


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## ALittleBitCrunchy (Jan 8, 2005)

I'd take her to a doctor and have her tested for diabetes. It's a quick blood check and urine dip. My daughter was 2 when she was diagnosed with Type 1 diabetes and it took 5 minutes in the office.


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## Ruthla (Jun 2, 2004)

Quote:


Originally Posted by *leila1213* 
Another question I just thought of: the test also talks about how you can use it if you are on a low-carb diet to see if you are in ketosis. What is the difference between ketosis and ketoacidosis? Is it possible she just hasn't had a lot of carbs lately and that has put her into ketosis? What is the danger of that?

There is no danger of ketosis for anybody of any age (barring any metabolic disorders)- the only danger, really, is that it might mask ketoacidosis.

If she eats a lot of sweets, she wouldn't be in the healthy kind of ketosis- that would come from filling up on protein and fat with very few carbs. I'm not sure if breastmilk has few enough carbs (from lactose) compared to the protein and fat to induce ketosis. Maybe give her some juice or fruit and test her urine again?


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## sbgrace (Sep 22, 2004)

Leila, it would take a severely restricted diet carb wise to put her in ketoacidosis. Breastmilk certainly has too many carbohydrates to cause it. Diet for that has almost no carbs at all and very high fat.

I don't understand what your hesitation is. You have enough symptoms that point to an issue--you need actual medical labs now. She needs to be screened for diabetes. If it isn't that I'd suggest a urine metabolic screen. But diabetes seems like a first step.

There is no reason to wait and in fact if indeed she's in acidosis that can be very dangerous and damaging.

http://www.netdoctor.co.uk/diseases/...eschildren.htm
She has warning signs. You detected possible ketones in the urine. She has sweet smelling breath at times.

Don't wait for her to get sick. Take her to get tested.


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## superstella (Aug 25, 2006)

I have to agree with Rachelle, take her for labs. The tests aren't a big deal at all, and as a pp pointed out took less than 5 minutes in the office to dx.

Quote:

There is no reason to wait and in fact if indeed she's in acidosis that can be very dangerous and damaging.








:


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## leila1213 (Sep 15, 2006)

Thank you I will do that this week. I guess I just feel like I'm being a hypochondriac since she has no other symptoms. Also I am scared that we will be starting a cycle that might mean we are doing tests and drugs that necessitate other tests and drugs, and get farther and farther from fixing her diet and the underlying cause. KWIM?


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## Thalia the Muse (Jun 22, 2006)

You aren't being a hypochondriac at all! She has symptoms that, at the very least, mean you should get a doctor to rule out some very serious possible causes. If it's a false alarm, then great! Pediatricians get those all the time.

Her diet might not be the problem -- if she's Type I diabetic, diet alone won't solve the problem, the underlying cause is genetic.


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## superstella (Aug 25, 2006)

Quote:


Originally Posted by *leila1213* 
Thank you I will do that this week. I guess I just feel like I'm being a hypochondriac since she has no other symptoms. Also I am scared that we will be starting a cycle that might mean we are doing tests and drugs that necessitate other tests and drugs, and get farther and farther from fixing her diet and the underlying cause. KWIM?

I totally understand that, but the basic labs can at least rule out serious issues like diabetes and then you can work on addressing the diet issues and underlying causes without having to worry that you're overlooking something serious. And yes, peds (all HCP probably) see plenty of false alarms all the time. In this case, however, I think at least blood sugar levels and urine tests are in order, and if those came back okay then start working on the underlying diet issues or whatever.

keep us posted!


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## leila1213 (Sep 15, 2006)

I think I mentioned that we don't yet have a regular dr in the city we're in now. There is a quick clinic right down the street though. Should I just march in and say that we want to test her for diabetes?


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## CrunchyGranolaMom (Feb 5, 2002)

YES!!!!!!

You are messing around with what could be a VERY serious situation, and one that is also causing you a lot of mental stress. If she is diabetic, you really need to deal with it ASAP. If she is not, you will have a big load off your mind.

Please take her in as soon as possible (like find out if they're open tonight and take her now) and report back. I hate to scare you, but kids with untreated diabetes can get very sick and even die.

Sending you strength,

CGM (RN, MSN in pediatric nursing)


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## Thalia the Muse (Jun 22, 2006)

Yep, just march in. We use the quick clinic down the street from us all the time because it's so hard to get appointments with a primary care doctor on our insurance, and it is easy as pie. The test shouldn't cost a fortune, either.

Just say "My daughter has these symptoms, X, Y, and Z, that make us concerned about juvenile diabetes. Can you please test her?" They may also have some helpful suggestions for follow-up if it isn't diabetes.


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## jeliphish (Jul 18, 2007)

better safe than sorry. If she is exhibiting symptoms then what is the harm in taking her in? If it is in fact type 1 diabetes then serious damage if not death can occur without treatment- that wouldn't be something that I (as a non medical professional) would be willing to try to treat myself. Like someone esle said- type 1 diabetes cannot be treated with diet alone.
Test strips are used to monitor blood sugar levels - NOT diagnose a potential disease or lack of disease.


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## lindberg99 (Apr 23, 2003)

Yes, take her in. Even if you feel like you're overreacting.

And hopefully it does turn out that you were overreacting. But so what?? I figure every parent goes through the whole taking them to the doctor and finding out it's nothing once in a while.

They really are not going to care at the clinic. It's not like you're marching in there every day demanding an MRI or an angiogram or something. It's a blood sugar test that takes 5 min.


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## Kabes (May 17, 2004)

Please go asap! I am a former paramedic and I have been called for a child who was later diagnosed with diabetes, it was very scary. Do not feel silly, you are protecting your DD. The peace of mind in knowing will be priceless.


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## Heavenly (Nov 21, 2001)

Quote:


Originally Posted by *leila1213* 
Thank you I will do that this week. I guess I just feel like I'm being a hypochondriac since she has no other symptoms. Also I am scared that we will be starting a cycle that might mean we are doing tests and drugs that necessitate other tests and drugs, and get farther and farther from fixing her diet and the underlying cause. KWIM?

If she has diabetes you will be starting a cycle of treating your daughter and not letting her die. Sorry to be blunt but possible diabetes is nothing to mess around with. I hope you have taken her to a doctor by the time you read this post.


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## leila1213 (Sep 15, 2006)

OK, so here's the deal. DD took a reeeeeally long nap. I was worried and wanted to take her in to the dr so I got her up and could tell right away that she was feverish. DH also felt feverish and achy yesterday. I did another ketone test of her urine and it was still in the mod/high range. I went to the urgent care clinic (left DD with DH) and talked to a nurse about it. She said that they could do a fasting or postprandial finger stick but that this would probably not a good time to test because of her being sick. Fighting an infection will cause her to spill ketones and sugar into her blood and urine and essentially cause a false positive. So I thought I would take her in tomorrow morning for a postprandial finger stick (since she nurses all night & thus we wouldn't have a reliable fasting time), and also contact a ped in the area to see what they have open. The urgent care clinic felt that a ped would be better suited for any testing more extensive than the finger prick. I would definitely want to get EMLA cream for a blood draw if that is needed. What do you all think?


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## CrunchyGranolaMom (Feb 5, 2002)

I would say keep a close eye on her and if your "mom sense" tells you to, PLEASE take her to the ER. (disclaimer: I am not in the endocrinology field)

btw, they can test in the blood for Hemoglobin A1C, which gives a three-month view of glucose control, so even if your dd is sick w. a cold now, do not let that be a reason to delay looking into this.

Can you call about seeing a pediatric endocrinologist, who would specialize in kids w. diabetes? You would really want someone to quickly either rule this in and get her treatment, or rule it out and let you get on with your life....

From Wikipedia, here are signs and symptoms of ketoacidosis. Please notice now some/much of what you have described about your dd fits this pattern:

"It is important to note that to an untrained person the symptoms of acute DKA, such as breath odor, are very similar to alcohol intoxication, and it is easy to assume that the person is drunk instead of suffering from a diabetic emergency.

* Sluggishness, extreme tiredness.
* Extreme thirst, despite large fluid intake.
* Constant urination
* Fruity smell to breath, similar to nail polish remover.
* Hyperventilation, at first rapid and shallow, then progressively deeper and less rapid.
* Extreme weight loss.
* Oral Thrush and/or persistent vaginal yeast infections may be present; this is because the normal fungal flora present in the oral cavity and cervix is disrupted
* Muscle wasting.
* Agitation / Irritation / Aggression / Confusion

Late signs

At this point, DKA is life-threatening and medical attention should be sought immediately.

* Emesis (vomiting), although this is not always a sign of late-stage ketoacidosis, and can occur both in early-stage ketoacidosis and in non-ketoacidic hyperglycaemia.
* Confusion.
* Abdominal pain.
* Loss of appetite.
* Flu-like symptoms.
* Lethargy and apathy.
* Extreme weakness.
* Kussmaul breathing ("air hunger"). A type of hyperventilation where patients breathe very deeply at a normal or increased rate. This is a sign of severe acidosis.
* Unconsciousness (a variety of diabetic coma) after prolonged DKA. At this stage, speedy medical attention is imperative."

Again, if you remain concerned during the night, please take her to an ER.

Good luck.


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## Justice2 (Mar 18, 2003)

Quote:


Originally Posted by *purplepaisleymama* 
Your memory isn't going, that is a sign of ketoacidosis and of early diabetes. It can also be a sign of metabolic issues and of allergies, though I don't know which ones. I just posted a response to another similar question, I would post on the special needs forum, sometimes moms there are familiar with the different reasons these things happen.
Hope that you get an answer soon,
laura

Hi there! Just as a side note, ketoacidosis has a VERY distinct smell, and at that point your child would be extremely ill. Odds are Ketoacidosis is not what you are dealing with! I really wouldn't worry about that! However, if you feel it's necessary, a simple blood test will help you do figure out whether or not it could be the beginning stages of JD.


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## RoadToAvonlea (Nov 13, 2008)

Quote:


Originally Posted by *leila1213* 
Oh great. So what exactly does that mean? I guess I need to find a good holistic practitioner to help, because I'm obviously not having success on my own. *Would a naturopath be a good choice?*

No. At least, not at first. You need an endocrinologist for diabetes, at least in the beginning. I know MDC frowns upon the suggesting "doctors", but you really will need to see a doctor in order to get a referral. Once the endo gets things stabilized (and diagnosed, if it is in fact diabetes) then you can see a naturopath. Even better is a clinical nutritionist, as dietary management is really import. BUT... but, but, but, if you suspect your child has diabetes, please go see a _doctor_ first (as in the kind that has access to diagnostic testing who can refer you out if need be).


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## momofmine (Jan 8, 2007)

Quote:


Originally Posted by *RoadToAvonlea* 
please go see a _doctor_ first (as in the kind that has access to diagnostic testing who can refer you out if need be).

Actually, a licensed naturopathic physician, if you are in a state that licenses them, can draw blood and order diagnostic tests. They can even prescribe some pharmaceutical drugs, like some antibitoics for things like ear infections. They have four-year graduate degrees too.

To the OP, I think I would go on what the nurse said, that you can spill ketones in your urine with an infection, it would make sense, esp since your DH is sick too. I would also try to find an alternative HCP in your area asap. Try contacting your local La Leche League, or local homebirth midwives. They often know about alternative-minded HCP's. There are even MD's who are alternative-minded and use alternative medicine exclusively. You mentioned Richmond, is that Virginia? There is an organization called Birth Matters that is a statewide organization that I bet could point you to some alternative providers.

Here you go:

http://www.birthmattersva.org/resour...ort_groups.htm

Hope that helps, and hope your little one is feeling better soon.


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## leila1213 (Sep 15, 2006)

We are going to the urgent care clinic for a postprandial finger stick, then calling some MD's that I've gotten recommendations for.

Just to ease people's minds a little bit though, she has not been sluggish or lethargic AT ALL, aside from a long nap yesterday. Seriously, you should see this little thing bouncing off the walls. She is obviously doing much better after a little fever spike. I took her ketones again this morning and it was in the small range.


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## Mommyto2girls (Nov 20, 2008)

My Mom is a Type 1 diabetic, diagnosed at age 9. I worry about this all the time with the girls. All the Dr's in my ped office said that one of the main symptoms in little ones that are diabetic are soaking diapers contantly and drinking a lot.

If your child is not feeling well and not eating as usual it is normal to have ketones in their urine.

I agree with the others, if you have any sort of inkling that she may be diabetic get her checked because the last thing you want is to her end up in the hospital from whacked out sugars.


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## earthmama369 (Jul 29, 2005)

Quote:


Originally Posted by *leila1213* 
Thank you I will do that this week. I guess I just feel like I'm being a hypochondriac since she has no other symptoms. Also I am scared that we will be starting a cycle that might mean we are doing tests and drugs that necessitate other tests and drugs, and get farther and farther from fixing her diet and the underlying cause. KWIM?

Right now, tests will get you answers -- at least they'll rule out some possibilities -- so you have a basis for fixing the problem, whether it's with medication or diet (or both, depending on the problem). Without the tests, you're flying blind. Some things can be figured out at home, some can't, and this is one of those situations where I'd be seeking medical advice. It's not a roller coaster, you can always get off.









ETA: Just caught up with the rest of the thread and obviously you're already seeking help. Good luck in finding some answers and I'm glad to hear your little girl is bouncing off the walls!


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## leila1213 (Sep 15, 2006)

Just got back from the urgent care clinic. The dr was very condescending, but I think I got the info I need. Her blood sugar was 86, which sounds very good.







:

Here are the results of the urinalysis:

GLU Negative
BIL Small
KET 80 mg/dl
SG >=1.030
BLO Negative
pH 5.5
PRO Negative
URO 0.2 E.U./dl
NIT Negative
LEU Negative

Sounds like she just needs to eat and get rehydrated?? Any other input?

Thank you everyone for all your advice!!


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## CrunchyGranolaMom (Feb 5, 2002)

SO glad to hear it. May she only know good health!


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## lindberg99 (Apr 23, 2003)

Glad it's nothing serious!!


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