Use of Parenteral Medium‐Chain Triglyceride Emulsion for Maintaining Seizure Control in a 5‐Year‐Old Girl with Intractable Diarrhea

Rosenthal, Elana; Weissman, Barbara; Kyllonen, Kay

doi:10.1177/0148607190014005543

Cited by 13 publications

(11 citation statements)

References 19 publications

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“…The aim of PN during KD treatment in children with refractory epilepsy is to maintain ketosis and seizure control when enteral feeding is temporarily impossible. So far, few data on kPN have been published . These data showed the safety of kPN in children, but did not provide a basis for a standardized approach to prescribe kPN.…”

Section: Discussionmentioning

confidence: 99%

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Ketogenic parenteral nutrition in 17 pediatric patients with epilepsy

et al. 2017

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SummaryObjectiveKetogenic parenteral nutrition (kPN) is indicated when enteral intake is temporarily limited or impossible, but evidence‐based prescriptions are lacking. Objective was to evaluate the efficacy and safety of kPN in children with epileptic encephalopathies using a new computer‐based algorithm for accurate component calculating.MethodsChildren with epilepsy receiving kPN were included. A computer‐based algorithm was established on the basis of guidelines of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN): fat intake not exceeding 4 g/kg/day, age‐adequate supply of protein, electrolytes, vitamins, and trace elements, but reduced carbohydrates. Primary outcome was successfully reaching relevant ketosis, defined as beta‐hydroxybutyrate plasma level of ≥ 2 mmol/L. Efficacy was defined as seizure reduction ≥50% in de novo kPN and maintenance of response in children already on a ketogenic diet (KD). Safety was assessed by adverse effects, laboratory findings, and the appropriateness of nutritional intake.ResultsSeventeen children (median 1.84 years) were studied, of which 76% (13/17) were already on an oral ketogenic diet. Indications for kPN were surgery, status epilepticus, vomiting, food refusal, and introduction of enteral feeding in neonates. The parenteral fat/nonfat ratio was mean 0.9 (±0.3; range 0.6–1.5). Relevant ketosis was reached in 10 children (median 2.9 mmol/L), but not in 7 (median = 1.4 mmol/L). In de novo kPN, significant response was observed in 50% (2/4); in patients previously responding to the KD (77%, 10/13), response was maintained. A significant correlation between the degree of ketosis and seizure reduction (correlation coefficient = 0.691; p = .002) was observed. Only mild and transient adverse events occurred during kPN.Significance KPN with fat intake of 3.5–4.0 g/kg/day was safe and effective. KPN was tailored according to guidelines and individual nutritional needs. In nearly half of the patients, ketosis was lower than during oral KD. Despite this, seizures remained controlled.

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Section: Discussionmentioning

confidence: 99%

“…During KD treatment, maintenance of adequate ketosis is the primary goal. To date, information on efficacy and safety of kPN during treatment with the KD is limited: so far, only 5 case reports and 1 retrospective study provided data on a variety of approaches in infants for initiation and maintenance of a kPN …”

Section: Introductionmentioning

confidence: 99%

Ketogenic parenteral nutrition in 17 pediatric patients with epilepsy

et al. 2017

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“…On the basis of the data from KD-PN studies [11][12][13][14][15][16][17][18][19]38 and in clinical practice, it is clear that, during KD-PN, side effects are frequently documented even if parenteral nutrition is only given for a few days.…”

Section: Side Effects and Monitoringmentioning

confidence: 99%

“…Recently updated international guidelines (European Society for Clinical Nutrition and Metabolism/European Society for Paediatric Gastroenterology Hepatology and Nutrition and the American Society for Parenteral and Enteral Nutrition) on parenteral nutrition are not applicable to KDT for the amount of carbohydrates recommended to initiate ketosis. There are currently limited data available on ketogenic diet parenteral nutrition (KD‐PN), with only 35 cases reported in the literature . Only the White Paper from the Charlie Foundation provides brief recommendations for KD‐PN practice…”

mentioning

confidence: 99%

“…There are currently limited data available on ketogenic diet parenteral nutrition (KD-PN), with only 35 cases reported in the literature. [11][12][13][14][15][16][17][18][19] Only the White Paper from the Charlie Foundation provides brief recommendations for KD-PN practice. 20 This paper highlights recommendations based on the best evidence combined with opinions of an international group of experts.…”

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confidence: 99%

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Optimal clinical management of children receiving ketogenic parenteral nutrition: a clinical practice guide

Louw

Aldaz

Harvey

et al. 2019

Develop Med Child Neuro

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AimTo give evidence‐based recommendations on the application of ketogenic diet parenteral nutrition (KD‐PN) in emergency situations.MethodAn international group of experts (n=14) researched the literature and distributed a survey among 150 expert centers. International accepted guidelines (European Society for Clinical Nutrition and Metabolism/European Society for Paediatric Gastroenterology Hepatology and Nutrition and the American Society for Parenteral and Enteral Nutrition) and handbooks for parenteral nutrition were considered general standards of care.ResultsIn the literature, we identified 35 reports of patients treated by KD‐PN. International guidelines and handbooks provided some conflicting information. Twenty‐four expert teams from nine countries responded to the survey, reflecting the limited clinical experience.InterpretationThis paper highlights 23 consensus‐based recommendations for safe and effective KD‐PN (e.g. diet initiation, calculation, application, monitoring, and evaluation) based on the best evidence available and expert opinions.What this paper adds In acute settings, ketogenic diet therapy (KDT) can be administered parenterally.Parenteral administration of KDT should be started only at the intensive care unit.Initiate ketogenic parenteral nutrition stepwise to the highest ratio possible with the lowest level of complications.Evaluate the risk–benefit ratio of parenteral administration continuously.Restart enteral feeding as soon as appropriate.

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