Sweet Smelling Urine in 25 month old

[bellabeanmom]

My 26 month old recently started having very sweet, at times obnoxiously sweet, sick smelling urine (it does not smell like maple syrup, it has a very sweet fruity like smell is my best guess at a description).  It has been happening for approximately two months.  At first, I thought that it was a new brand of diapers that we were using that seemed to coincide with it starting, but about two weeks ago, we switched back to the old brand of diapers that we had been using, and it has not gone away.  The smell is sometimes weak - but still to point that it is smelly without having to purposefully smell near her diapers.  At other times it has been so overwhelming that it has made me sick to my stomach just to breathe in while I am changing her.  We took her to her ped's office last weekend where they did a quick test of her urine and determined that it did not have sugar in it.  They did find presence of WBC, so they cultured it, but being that she is not potty trained and they had to catch the urine in an attached bag, it came back contaminated.  That day we went back and they catherized her to get a clean catch.  We're still waiting on results of that culture to come back.

I don't know if this important or not, but she also started about the same time waking up (and has done this at least once fully awake) screaming that her leg (always her left leg - calf area) is hurting her and will stay awake screaming in pain (even with dose of Motrin prior to going to bed - I tried that for a week to see if it made any difference) for about 10-20 minutes.  This happens at least once or twice a week, and has for about 2 months.

Any ideas as to what I should be concerned about with this?  Our initial thought with the urine is diabetes - we have such a strong familial chance for this - my husband, his father, all of my relatives (myself even having gestational diabetes) have Type II and there are some close relatives of my husband with Type I diabetes - but the doctor said there was no concern of that since she was not spilling sugar...

[AnnieBrooke]

If you think there is any chance it is diaper-related, there are diapers on the market that have no scent at all, and you could try them to see if you still smell it.  Then I would see if you can get her normal pedi to recommend a specialist.  It's obviously not normal.  Pediatric endocrinologist, perhaps?  

[AnnieBrooke]

Also, the sickly sweet smell you mention sounds like it could possibly be from spilling ketones in the urine.  When someone has a medical condition that is worse at some times than at others, she should be seen when it is happening, so if the day you had your little one in to the pedi she was not showing particular symptoms, take her back at a time when she is.  If your concerns get the brush-off, try a different doctor.  What's going on is not usual for a child, and shouldn't be ignored by her doc.

[AnnieBrooke]

The following is from another MedHelp forum:

My 14 mo. old daughter has vesicoureteral reflux, so her urine is checked periodically. .... Lately, when her urine is checked, ketones are present in a moderate amount, but not glucose. I am wondering if this could be the first clue to diabetes ... . I know that dehydration can cause these ketones to "spill," but a urinalysis the other day showed ketones and she is well. She has not truly displayed any other signs that concern me except that when she awoke this morning she wet through her diaper and EVERYTHING was soaked in her crib. I know babies do this, as she is my third, but she never has before ... Any information would be appreciated as to why this may be happening and if it is significant.

Thank You!
Cyndi

Dear Cyndi:

Ketones in the urine reflect alterations in customary body metabolism. As you note, ketones are most often found in the urine during illness when children eat less. During such times, since little sugar is stored in the body, they metabolize their body fat as a source of energy. Ketones appear in the urine as a result. Ketones [also] appear in children who have underlying severe inborn errors of metabolism [but those] children are obviously ill.  It is true that children with diabetes mellitus spill ketones in the urine, but they spill sugar simultaneously. In fact, sugar appears in the urine in a child with diabetes before ketones do. Ketones may appear in the urine of otherwise healthy children, in association with hypoglycemia. There is a form called ketotic hypoglycemia, which occurs in young children who are particularly susceptible to fasting. Your note does not suggest that you daughter has ever had low blood sugar. She conceivably might be having low blood sugar when she is asleep and the ketones in her urine [although] she is well might be reflecting this. Ketotic hypoglycemia is outgrown. Your pediatrician will be able to provide additional assistance to you.

Thus information is provided for educational purposes only. I hope it steers you in the right direction.

HFHS.MD.HSW