<s>[INST] my daugher has a bad cold, severe fatigue, moderate temp. nausea and vomiting, cough with pain in back ( lower) tthey said she had plus four ketones, and respiratory infection. and needed treatment ,liter of IV fluids zofran ( pres) and zpac. they could not get vein for IV and on discharge no antibiotic because doc said if would have interaction with zofran. the nurse said sorry, you are the only iv i have ever missed. my God should they send someone home with a plus four ketone my daughter is still so sick, I am very disappointed in [/INST] Thanks for posting on Chat Doctor. I am sorry to hear about your daughter. During illness when the child does not eat properly, the body has to manage nutrition from elsewhere and converts fats to ketones which act as the food for brain. That is probably the reason for your child to have 4+ ketones. All that has to be done is to give her feed properly. I would also insist giving her ORS to help her regain salt and water imbalance. At times, it is extremely difficult to find the vein in small child Chat Doctor.  </s>