Q:

A 3-year-old boy presented to emergency unit at 9:00 AM with history of difficult arousal from sleep

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A 3-year-old boy presented to emergency unit at 9:00 AM with history of difficult arousal from sleep, flue like illness, and low grade fever; the mother stated that he had slept without having his supper. Fasting blood sugar was 42 mg/dL. The following metabolic changes are seen in this condition EXCEPT


  1. ketonuria
  2. lowinsulin level
  3. high alanine level
  4. high cortisol level
  5. high growth hormone level

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(C). Children with ketotic hypoglycemia have plasma alanine concentrations that are markedly reduced in the basal state after an overnight fast and decline even further with prolonged fasting. Alanine, produced in muscle, is a major gluconeogenic precursor.

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