Hypoketotic Hypoglycemic Coma in a 21-Month-Old Child, , ,

We present the case of a 21-month-old child with hypoketotic hypoglycemic coma. The differential diagnosis initially included metabolic causes versus a toxicologic emergency (unripe ackee fruit poisoning). Using information obtained from the emergency department, the diagnosis was confirmed as the late-onset form of glutaric acidemia type II. This case illustrates the importance of emergency physicians in the diagnosis and management of children with inborn errors of metabolism. [Hostetler MA, Arnold GL, Mooney R, Bennett MJ, Rinaldo P, Roe CR: Hypoketotic hypoglycemic coma in a 21-month-old child. Ann Emerg Med September 1999;34:394-398.]