A 10-year-old boy with spinal muscular atrophy presents with nausea and vomiting, and lab results show severe hypoglycemia. Which metabolic condition is he likely experiencing?

The scenario presented describes a 10-year-old boy with spinal muscular atrophy experiencing nausea, vomiting, and severe hypoglycemia. Given his condition, the most likely metabolic issue he is encountering is starvation ketoacidosis.

Starvation ketoacidosis occurs when the body is deprived of carbohydrates and begins to use fat stores for energy, leading to the production of ketone bodies. This process typically happens during prolonged periods without food intake, such as in cases of severe illness, muscle wasting, or conditions affecting appetite or feeding, like spinal muscular atrophy. The boy's symptoms of nausea and vomiting, alongside hypoglycemia, suggest his body is unable to maintain normal glucose levels due to a lack of glycogen stores and an inability to generate glucose from non-carbohydrate sources.

While glycogen storage disease might be a possibility, it generally presents with more chronic symptoms or specific enzyme deficiencies rather than acute severe hypoglycemia that is often associated with metabolic decompensation after fasting. Acute kidney injury would not typically present with hypoglycemia as the primary issue, and type 1 diabetes mellitus usually leads to hyperglycemia rather than hypoglycemia unless there is an insulin overdose or other complex factors involved.

Thus, the clinical picture aligns best with starvation