Practical Considerations for Ketogenic Diet in Adults With Super-Refractory Status Epilepticus

Kaul, Neha; Laing, Joshua; Nicolo, John‐Paul; Nation, Judy; Kwan, Patrick; O’Brien, Terence J.

doi:10.1212/cpj.0000000000001009

Cited by 6 publications

(6 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Sodium < 130 mg/dl, > 150 mg/dL; albumin corrected calcium < 8 mg/dl [26] Severe hypoglycemia (glucose < 54 mg/dl) [27] Disease state Pregnancy [28,29] Severe coagulopathy…”

Section: Severe Metabolic Abnormalities or Instabilitiesmentioning

confidence: 99%

“…Severe liver failure; aspartate aminotransferase (AST), alanine aminotransferase (ALT), ammonia > 5*upper limit of normal; total bilirubin > 15 mg/dl, direct bilirubin> 5 mg/dl within 24 h) [26] Severe kidney failure [29] Pancreatitis Irreversibly decerebrate patients [30] Critical cardiovascular instability [30] Infants with less than 8 cm of the small bowel [30] Drugs…”

Section: Severe Metabolic Abnormalities or Instabilitiesmentioning

confidence: 99%

See 1 more Smart Citation

Calculation and management of ketogenic diet parenteral nutrition in super-refractory status epilepticus

Zeng

Mei

Zhou

2022

Acta Epileptologica

View full text Add to dashboard Cite

Super-refractory status epilepticus (SRSE) is an important neurological emergency associated with high mortality and morbidity and poses a heavy economic burden on patients. Ketogenic diet parenteral nutrition (KD-PN) is ketogenic diet therapy provided through parenteral administration and may be an adjuvant treatment for these who cannot accept enteral diet. However, the calculation and management of KD-PN presents a challenge for clinicians. This review focuses on the practical aspects of KD-PN therapy for treatment of SRSE, including the dietary composition, potential drug-diet interactions, and monitoring during KD-PN treatment. As with all SRSE treatments, KD-PN has many adverse effects, like hyperlipemia, hepatotoxicity, metabolic acidosis, insufficient ketosis or hyper-ketosis, and propofol infusion syndrome. We summarize monitoring and treatment methods in our review. This review provides some practical aspects for treatment of SRSE.

show abstract

“…Sodium < 130 mg/dl, > 150 mg/dL; albumin corrected calcium < 8 mg/dl [26] Severe hypoglycemia (glucose < 54 mg/dl) [27] Disease state Pregnancy [28,29] Severe coagulopathy…”

Section: Severe Metabolic Abnormalities or Instabilitiesmentioning

confidence: 99%

Section: Severe Metabolic Abnormalities or Instabilitiesmentioning

confidence: 99%

Calculation and management of ketogenic diet parenteral nutrition in super-refractory status epilepticus

Zeng

Mei

Zhou

2022

Acta Epileptologica

View full text Add to dashboard Cite

show abstract

“…Inborn errors of metabolism are a contraindication to KD [ 35 , 36 ]. However, these conditions most often present in early childhood, and rarely in adults, so screening is not routinely obtained prior to KD initiation in adults [ 1 , 2 ]. Other contraindications of KD include unstable metabolic (mitochondrial enzyme deficiencies) conditions, liver failure, acute pancreatitis, pregnancy and an inability to tolerate enteral feeds [ 5 ].…”

Section: Question: What Are Some Factors Should the Clinician Consmentioning

confidence: 99%

“…Status epilepticus (SE) carries an exceedingly high mortality and morbidity, often warranting an aggressive therapeutic approach. Recently, the implementation of ketogenic diet (KD) in adults with refractory and super-refractory SE has been shown to be feasible and potentially effective [ 1 , 2 , 3 , 4 , 5 ]. Most often used in childhood epilepsies, KD has emerged as a potential adjunctive treatment for pediatric SE [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Pearls and Pitfalls of Introducing Ketogenic Diet in Adult Status Epilepticus: A Practical Guide for the Intensivist

Katz

Owusu

Nussbaum

et al. 2021

JCM

View full text Add to dashboard Cite

Background: Status epilepticus (SE) carries an exceedingly high mortality and morbidity, often warranting an aggressive therapeutic approach. Recently, the implementation of a ketogenic diet (KD) in adults with refractory and super-refractory SE has been shown to be feasible and effective. Methods: We describe our experience, including the challenges of achieving and maintaining ketosis, in an adult with new onset refractory status epilepticus (NORSE). Case Vignette: A previously healthy 29-year-old woman was admitted with cryptogenic NORSE following a febrile illness; course was complicated by prolonged super-refractory SE. A comprehensive work-up was notable only for mild cerebral spinal fluid (CSF) pleocytosis, elevated nonspecific serum inflammatory markers, and edematous hippocampi with associated diffusion restriction on magnetic resonance imaging (MRI). Repeat CSF testing was normal and serial MRIs demonstrated resolution of edema and diffusion restriction with progressive hippocampal and diffuse atrophy. She required prolonged therapeutic coma with high anesthetic infusion rates, 16 antiseizure drug (ASD) trials, empiric immunosuppression and partial bilateral oophorectomy. Enteral ketogenic formula was started on hospital day 28. However, sustained beta-hydroxybutyrate levels >2 mmol/L were only achieved 37 days later following a comprehensive adjustment of the care plan. KD was challenging to maintain in the intensive care unit (ICU) and was discontinued due to poor nutritional state and pressure ulcers. KD was restarted again in a non-ICU unit facilitating ASD tapering without re-emergence of SE. Discussion: There are inconspicuous carbohydrates in commonly administered medications for SE including antibiotics, electrolyte repletion formulations, different preparations of the same drug (i.e., parenteral, tablet, or suspension) and even solutions used for oral care―all challenging the use of KD in the hospitalized patient. Tailoring comprehensive care and awareness of possible complications of KD are important for the successful implementation and maintenance of ketosis.

show abstract

“…Use of dietary therapies for emergency inpatient indications (e.g. status epilepticus) has been discussed elsewhere [11].…”

Section: Introductionmentioning

confidence: 99%

Practical considerations of dietary therapies for epilepsy in adults

Kaul

Nicolo

O’Brien

et al. 2021

Acta Epileptologica

Self Cite

View full text Add to dashboard Cite

Despite the increasing number of anti-seizure medications becoming available, the proportion of patients with drug-resistant epilepsy remains unchanged. Dietary therapy for epilepsy is well-established practice in paediatric care, but relatively underutilised in adults. Recently, international recommendations have been published to guide the treatment of adults receiving dietary therapy for epilepsy. This review focuses on the specific aspects of care unique to the management of adults receiving dietary therapy for epilepsy, including patient selection, diet composition, initiation, monitoring and cessation of dietary treatment. We emphasise the need for a multidisciplinary team approach with appropriately trained neurologists and dietitians to provide holistic care while the patients are receiving dietary therapy. Future research should focus on the optimal diet composition and meeting the psychosocial needs of adults with epilepsy to maximise efficacy and adherence to dietary treatment.

show abstract

Practical Considerations for Ketogenic Diet in Adults With Super-Refractory Status Epilepticus

Cited by 6 publications

References 42 publications

Calculation and management of ketogenic diet parenteral nutrition in super-refractory status epilepticus

Calculation and management of ketogenic diet parenteral nutrition in super-refractory status epilepticus

Pearls and Pitfalls of Introducing Ketogenic Diet in Adult Status Epilepticus: A Practical Guide for the Intensivist

Practical considerations of dietary therapies for epilepsy in adults

Contact Info

Product

Resources

About