In this section
Definition of Terms
Management of dehydration
Management of excessive ketosis
The Ketogenic Diets (KD) are a recognised treatment option for some children with refractory epilepsy and Glucose transporter 1 deficiency syndrome (Glut 1 DS). The Royal Children’s Hospital offers two types of ketogenic diet: the classical or modified Atkins diet (MAD). The KD diet has some potential side effects, but is generally well tolerated. Many childhood illnesses can be managed at home.
When a child on a KD becomes unwell and presents to hospital, the illness and its effect on the diet requires assessment. Children on a KD will usually require hospital review if they present with the following:
The aim of this guideline is to provide a medical, nursing and allied health framework
for decision making in relation to the management of the unwell child on KD
Ketone bodies: Are
water-soluble compounds that are produced when excessive amounts of fat are broken down for
energy. In some circumstances they are
used as a source of energy in the heart
There are four key factors to the assessment of a child on KD therapy who is acutely unwell presenting to hospital for management.
child’s medical status
patient’s level of hydration
3) Establish if patient has excessive ketosis
4) Establish if patient has experienced change in usual level of ketosis
Contact General Medical Consultant:
Excessive ketoacidosis needs to be managed by the
administration of extra carbohydrate.
If ongoing excessive ketosis a child may require management with IV a Maintenance 5% Dextrose and Normal Saline or IV bolus.Note: an IV bolus of (30mls of 10% glucose is equivalent to 30mls lemonade/juice) and may be utilised if clinically appropriate.
Contact General Medical or Endocrinology Consultant if high ketosis and child unwell.
Please remember to read the disclaimer.
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 March 2019.