In this section
Ketogenic Diets (KD) are recognised treatment options for some children with refractory epilepsy and all children with Glucose Transporter Type 1 Deficiency Syndrome (GLUT1 DS). The Royal Children’s Hospital (RCH) offers three types of ketogenic diet: the classical, MCT diet (medium-chain triglyceride diet) or modified Atkins diet (MAD). The KD has some potential side effects but is generally well tolerated.
In many instances, childhood illnesses can be managed at home, however when a child on a KD becomes unwell the illness and its effect on the diet requires assessment. Appropriate management is important to avoid the effects of excessive ketosis and to also avoid loss of ketosis from administration of high carbohydrate containing products. Loss of ketosis can result in exacerbation of seizures. Children on a KD will usually require hospital review if they present with any of the following:
• vomiting and diarrhoea
• febrile illness,
• increased seizures.
The aim of this guideline is to provide a framework for decision making in relation to the management of the unwell child on KD therapy.
There are three key factors to the assessment of a child on KD therapy who is acutely unwell presenting to hospital for management.
Child’s medical status
Level of hydration.
Assess level of ketosis
Excessive ketosis needs to be managed if there are high ketones in combination with clinical signs of ketosis. It will usually require the administration of extra carbohydrate. (Guidance below assumes the carbohydrate content of 30ml
of undiluted, non-diet apple juice = 30mL 10% Glucose intravenous fluid = 10mL
oral sucrose 33% solution)
If ongoing excessive ketosis a child may require management with IV Maintenance 5% Dextrose and Normal Saline or IV bolus.
In some situations, Plasma-Lyte 148® with NO dextrose may be clinically indicated.
Management of Acute Illness when on a Ketogenic Diet.
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read the disclaimer.
The development of this nursing guideline was coordinated by Jill Bicknell-Royle, Epilepsy Nurse Coordinator, Department of Neurology, and approved by the Nursing Clinical Effectiveness Committee. Updated November 2023.