acidotic baby with cholestrone around mouth

A baby not getting enough breast milk would be HYPOglycemic and dehydrated. A metabolic imbalance would be a late sign. I would think you would see dry diapers, lethargy, etc long before a metabolic imbalance bad enough to produce an odor. Newborns aren't usually HYPERglycemic unless on IV therapy. I would suspect some metabolic disorder if a baby really smelled like acetone.

Translation:

Less volume = buildup of lactic acid = acidosis.

The more common term.

Fix? Feed more/IVF.

Metabolic acidosis and ketosis is not an uncommon finding in pediatric patients with volume depletion and/or dehydration. You can appreciate the pathology of the acidosis when considering the effects of decreased cellular perfusion: Loss of oxidative phosphorylation---> loss of the tricarboxylic acid cycle---> conversion of pyruvate to lactate and the eventual onset of lactic acidosis.

Are you talking about a baby just delivered or one that's got a few hours of age on him?