Successful Management of Ketogenic Parenteral Nutrition: A Pediatric Case Study

Lowe, Helen; Segal, Stacey; Mouzaki, Marialena; Langos, Veronika; Dlamini, Nomazulu

doi:10.1002/jpen.1490

Cited by 3 publications

(6 citation statements)

References 11 publications

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“…In the reported studies, the KD-PN was infused continuously over 12 h [16], 16 h [10,17,18,20], 20 h [11,15] and 24 h [19,21], and interrupted with 0.9% or 0.45% NaCl solution. For KD-PN, the infusion speed is mainly limited by the infusion of FEs.…”

Section: Infusion Speedmentioning

confidence: 99%

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

Zeng

Mei

Zhou

2022

Acta Epileptologica

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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.

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Section: Infusion Speedmentioning

confidence: 99%

“…KD-PN was first applied in 1990 to a 5-year-old girl with Lennox-Gastaut syndrome [9]. From 1990 to 2020, 6 retrospective studies [10][11][12][13][14][15] and 8 case reports [9,[16][17][18][19][20][21][22] have reported the use of KD-PN for epilepsy, involving a total of 47 patients (Fig. 1).…”

Section: Introductionmentioning

confidence: 99%

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

Zeng

Mei

Zhou

2022

Acta Epileptologica

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“…Postoji vrlo malo podataka kako se provodi parenteralna ketogena pre hrana. 24,25 Ipak, prije 2 godine objavljen je vodič za kli ničare o optimalnom kliničkom postupku za djecu koja primaju parenteralnu ketogenu dijetu. 26 Detaljan pregled bi bio preopširan na ovom mjestu, ali valja na pomenuti da su date 23 preporuke od strane međuna rodnog interdisciplinarnog tima.…”

Section: Raspravaunclassified

“…adekvat nom kontrolom epileptičkih napadaja. [24][25][26] Postoje još neki detalji u provođenju ketogene pre hrane. Primjerice, neki lijekovi mogu se otapati ili imati u sebi veći udio ugljikohidrata, što može negativno utje cati na njihovu učinkovitost.…”

Section: Raspravaunclassified

Personalized medicine – parenteral ketogenic diet in pyruvate dehydrogenase deficiency in the ICU; what do we need to know about it?

2022

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Prikaz slučaja | Case report Deskriptori MANJAK PIRUVAT DEHIDROGENAZE; MITOHONDRIJSKE BOLESTI; INTENZIVNO LIJEČENJE; KETOGENA DIJETA; PARENTERALNA PREHRANA; KONVULZIJE SAŽETAK. Manjak kompleksa piruvat dehidrogenaze (engl. Pyruvate Dehydrogenase Complex Deficiency, PDCD)rijedak je genetski neurometabolički poremećaj. Pripada u skupinu mitohondrijskih bolesti. Kliničke manifestacije se kreću od često smrtonosne, teške, novorođenačke laktacidoze do ozbiljnih neuroloških poremećaja kasnije tijekom života. Većina bolesnika ne doživi odraslu dob i rijetko je ova problematika nazočna u jedinicama intenzivnog liječenja odraslih bolesnika. Jedan od važnijih terapijskih postupaka kod ovih bolesnika je ketogena prehrana s visokim udjelom masti kojom se proizvode ketoni kao alternativno gorivo za tijelo i mozak. Ponekad može biti potrebna parenteralna ketogena prehrana koja još uvijek nije precizno definirana u postojećim smjernicama za prehranu bolesnika u jedinicama intenzivnog liječenja. Prikazano je provođenje parenteralne ketogene prehrane, te laboratorijski i klinički nadzor u 18-godišnje bolesnice s mitohondrijskom bolesti (PCDC) i to nakon abdominalnoga zahvata povezanog s upalnim komplikacijama, kada enteralna prehrana nije bila moguća. Prehrana je zahtijevala detaljni izračun osnovnih sastojaka kako bi se osigurala adekvatna opskrba energijom, volumenom i mikronutirijentima, a da bi se pri tome proizvela ketoza. Zajedno s ostalim metodama intenzivnoga liječenja, ovakav način prehrane pomogao je rješavanju komplikacija i ishodu liječenja ove epizode. U zaključku, pravilno propisana parenteralna ketogena prehrana kod bolesnika s PCDC smanjuje laktacidozu i učestalost neuroloških komplikacija. Treba je provoditi isključivo u jedinicama intenzivnoga liječenja, poglavito zbog nužnosti trajnog laboratorijskog i kliničkog nadzora. Kad god je moguće, treba ponovo što prije prijeći na enteralnu prehranu. Poželjno bi bilo imati i točno definirane smjernice za parenteralnu ketogenu prehranu.

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“…However, close monitoring for hepatoxicity and increased risk of developing pancreatitis is required. 31–33…”

Section: Practical Considerationsmentioning

confidence: 99%

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

et al. 2021

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PURPOSE OF REVIEWKetogenic diet therapy can be utilized as an adjuvant treatment of super refractory status epilepticus (SRSE). However, the drug and metabolic interactions with concomitant treatments present a challenge for clinicians. In this review we focus on the practical considerations of implementing ketogenic dietary therapy in the acute setting, including the dietary composition, potential drug-diet interactions, and monitoring during ketogenic treatment.RECENT FINDINGSThis report describes the ketogenic diet therapy protocol implemented for the treatment of SRSE and a review of the current evidence to support clinical practice.SUMMARYThe control of SRSE is critical in reducing morbidity and mortality. There is emerging evidence that ketogenic diet may be a safe and effective treatment option for these patients.

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Successful Management of Ketogenic Parenteral Nutrition: A Pediatric Case Study

Cited by 3 publications

References 11 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

Personalized medicine – parenteral ketogenic diet in pyruvate dehydrogenase deficiency in the ICU; what do we need to know about it?

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

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