Abstracts

In 1921, R.M. Wilder, MD theorized that the ketosis and acidosis resulting from minimal caloric intake produced an anticonvulsant effect. In recent years the ketogenic diet has become a common therapy for children with intractable seizures. The classic ketogenic diet involves an initial period of starvation that is followed by a diet consisting of a 3:1 or 4:1 ratio of fat to carbohydrate and protein. During the fasting period, children may become hypoglycemic and hyperketotic leading to nausea, vomiting and irritability. These complications frequently impair the child[apos]s ability to consume the diet successfully, often requiring additional days in the hospital. At least one death has been reported during the fasting period. For these reasons, the ketogenic diet is initiated under inpatient supervision at our facility without the traditional fasting phase. On the morning of admission, the child is allowed to eat his/her usual breakfast at home. Upon admission to the hospital, the child is fed ketogenic meals totaling 1/3 of his/her total daily caloric diet goal. On day 2 of admission, the child is fed 2/3 of his/her total daily caloric goal. Full calories are provided on day 3.
The medical charts of 50 consecutive children who consume their diets orally (vs. via feeding tube) were reviewed and the levels of urine ketones registered for each of the three days was recorded. Ketone levels were measured with urinalysis reagent strips and indicated as negative, trace, small, moderate or large. By day 3 of ketogenic diet initiation, 100% (50) of the children had registered large ketones on urinalysis reagent strips. Complications including hypoglyemia and/or emesis occurred in less than 20% of children. The average inpatient stay for these 50 children was 3.2 days. Our non-fasting protocol has allowed a smooth transition to the ketogenic diet while minimizing complications and inpatient hospital days.