2. It is a high fat, low carbohydrate and adequate
protein diet used in the treatment of intractable
epilepsy
It aims to decrease the number and severity of the
patients’ seizures
Therefore improving the quality of life and hopefully
reducing medication use
What is the ketogenic
diet?
3. Intractable childhood epilepsy*
*incomplete seizure control despite > 2 AED
GLUT 1 deficiency syndrome
PDH deficiency
Consider as early treatment for myoclonic astatic
epilepsy
Age not a barrier but works well in younger
children, e.g. under 10years
Indications for use
4. Randomised controlled trial at GOS 2008
150 patients
After 3 months 38% had >50% seizure reduction
compared with 6% in the control phase
7% had >90% reduction in seizures
Efficacy
5. Study also compared the Classical and MCT
(Medium Chain Triglyceride) diets
Results showed no difference in efficacy or
tolerability between the 2 diets after 3,6, and 12
months
Those on the MCT version had a little more nausea
Efficacy
6. Family agree to a 3 month commitment period on
the diet as there is a huge investment of professional
time
3 months is the best time scale to determine
outcomes
Diet usually advised for up to 2 years
Expectations from medical team and families need to
be discussed to assist future monitoring
Once selected
7. To achieve ketosis by providing fat for metabolism
To ensure that growth is adequate
To ensure nutritional well being is not compromised
To implement a dietary regimen that is palatable and
possible to comply with
The dietetic aims
10. Classical 4:1 and 3:1 ratio
i.e. Calorie controlled with 4 or 3 parts fat to 1 part
protein and carbohydrate combined
MCT diet (medium chain triglycerides)
Calorie controlled 40-60% energy from MCT allows a
little more flexibility but high MCT intake can lead to
nausea
Types of Ketogenic Diet
11. Modified Ketogenic diet
60% fat 30% protein 10% CHO
The carbohydrate intake is limited to approximately
20g per day
Less strict still needs good knowledge of foods to
choose
Energy intake monitored for weight control
Low Glycaemic Index (GI) diet
Energy distribution as above but choice of foods
with GI less than 50 typically high fibre foods
Total carbohydrate load 40-60g per day
Types of Ketogenic Diet
20. Growth: weight, height, and well being
Bloods, urine other tests e.g. ECG, renal USS
Record of seizures
Record of ketosis
-Blood use Abbott meter Freestyle Optium Neo (need lancets & ketone strips) aim 2-5mmol/l
-Urine use Ketostix aim for (+2 to +4)
or 8-16mmol/l
Monitoring
21. Nausea
Vomiting
Hypoglycaemia
Acidosis
Sleepiness
Dehydration
Diet refusal
Short term problems
22. Constipation
Renal stones
Abnormal lipid profile
Growth
Bone demineralization and fractures
Long term problems
23. Rapid panting or breathing
Facial flushing, vomiting
Irritability and unexpected tiredness
Acidosis
Blood ketone reading 6mmol/l or “Hi” with
symptoms
Treat with 1-2 tablespoons of sweet drink If no
improvement after 15 minutes repeat and contact Dr
Excess ketosis
24. If IV fluids needed use 0.9% saline
4 hourly blood glucose
Avoid sugar and carbohydrate containing drugs and
IV solutions
Illness
25. Carnitine
It is a protein which is necessary to carry fat into the
mitochondria to be broken down to energy (ATP)
KD high in fat therefore ↑need
KD low in lysine + methionine needed to synthesize
carnitine
↑Excretion of acylcarnitine with ketosis
Other considerations
