Acute metabolic decompensation: recognition and stabilisation

A 14-month-old child presents after a 2-day febrile illness with vomiting, lethargy, and a brief seizure. Glucose is 1.8 mmol/L with urinary ketones trace only; pH is 7.34 and ammonia is normal. **Discuss:** (1) the significance of hypoketotic hypoglycaemia and the most likely disorder family; (2) your initial investigation panel and the principles of first-hour management; (3) why reversing catabolism is the most powerful anti-toxin manoeuvre; (4) the long-term principles of preventing recurrence, including the role of the home emergency regimen.