Are ketones linked to diabetes?

Dear Doctor: What are ketones? I had a urine test and it was discovered that I had ketones. I have read around this and it is said ketones occur in diabetes, which I don’t have. What is my problem?
M. Kafuluma.

Dear Kafuluma: Ketones are substances produced when the body burns fat instead of glucose for energy.
Glucose is the sugar we burn to get energy. Ketones form when a person does not eat enough carbohydrates (like in starvation or high-protein diets) or when a person’s body cannot use carbohydrates properly, especially when one has diabetes.

When carbohydrates are not available, the body uses fat instead to get the energy it needs to keep functioning, leading to formation of ketones which will then be found in urine. When one has lots of ketones in blood, the blood is acidic instead of the usual alkaline, risking the dangerous condition, ketoacidosis.

Ketones in urine may be an early indication of diabetes and if not treated, can lead to dangerous diabetic ketoacidosis.
Severe exercise, exposure to cold, severe nausea and vomiting coupled with loss of weight during early pregnancy (severe morning sickness) can also increase fat utilisation for energy needs, resulting in ketones in urine.

Dear Doctor: My sister takes a lot of panadol (paracetamol) and magnesium. I think she is addicted. Is there any way she can be compelled out of this?

Staford Owaishemwe, Kagando

Dear Staford: Many people with abdominal pain resulting from peptic ulceration feel some temporary relief when they take the so-called magnesium, which is mostly sold locally in liquid or tablet form.
This magnesium combined with a painkiller such as panadol offers some people better relief.
Since the relief is temporary, one has to keep taking both drugs to stop the pain, which after a while, becomes recurring and this could be the reason you think your sister is addicted to both drugs.

In addition, one feels a continuous, strong urge to take something even when aware that it may be harmful to their health. This causes changes in the body, especially the brain, which leads to an overwhelming urge, which if not fulfilled, can lead to bad symptoms called withdrawal symptoms. This is common in abuse of drugs. The addiction is hard to stop.
If your sister is properly diagnosed and treated, she is likely to heal and stop taking panadol and magnesium.
However, it is unlikely that she is addicted to panadol and magnesium but she may be self-medicating for what is likely to be peptic ulceration.

Self-medication with magnesium can lead to complications such as cancer of the stomach, arisng from the suspected peptic ulcers.
Also, too much of magnesium taken with milk can cause problems of calcium and disturbance of the acid-base balance in the body.
Excessive intake of panadol may lead to liver damage and should therefore also be avoided.

Dear Doctor: My baby has a big kawompo (soft part of the head which runs up to the face) and it beats. Why is this so? Can it risk brain injury?

Esther Lunyolo

Dear Esther: A fontanelle locally known as kawompo is a soft spot atop a baby’s head which, during birth, enables the bones of the skull to overlap so that a big head can easily pass through the birth canal for baby delivery.
Though there are several on the head, the most prominent fontanelle is the one on top of the head. The fontanelles usually close by 18 to 24 months after allowing faster growth of the brain, unlike the skull closure which happens below two years. The fontanelles are usually firm and slightly sunken and may pulsate.

A tense or bulging fontanelle may indicate infection of the coverings of the brain, the brain itself, or fluid bathing the brain indicating increased pressure inside the skull.
Likewise, a significantly sunken soft spot may indicate dehydration.
When the infant is crying, lying down, or vomiting, the fontanelle may look like it is bulging, but it returns to normal when they calm down or when the baby is in an upright position.

If the soft spot does not normalise and the baby is irritable, has a fever or is drowsy, it should be taken to a doctor as an emergency.
Larger than normal fontanelles are most common in Down’s Syndrome, in cases where there is too much water bathing the brain (hydrocephalus), or where a baby’s growth in the womb was slow (intrauterine growth retardation) and in cases where a child is born before time (prematurity).
Please visit a doctor, especially a paediatrician, to rule out a medical problem.