Ketogenic Diets

and, Liz Neal; McGrath, G A

doi:10.1002/9780470692004.ch16

Cited by 4 publications

(4 citation statements)

References 33 publications

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“…The ketogenic ratio may be as high as 4:1 or 3:1 to achieve ketosis. [7][8][9][10] In such cases, protein is necessarily provided in adequate amounts for normal growth so that carbohydrate is strictly limited to 10% of the total energy requirement or <20 g carbohydrate per day. 10 Deviations from carbohydrate intake limits may result in loss of ketosis and seizure relapse.…”

Section: Introductionmentioning

confidence: 99%

“…The ketogenic ratio is determined as fat:non‐fat gram ratios (where non‐fat grams are grams of carbohydrate plus grams of protein). The ketogenic ratio may be as high as 4:1 or 3:1 to achieve ketosis 7‐10 . In such cases, protein is necessarily provided in adequate amounts for normal growth so that carbohydrate is strictly limited to 10% of the total energy requirement or <20 g carbohydrate per day 10 .…”

Section: Introductionmentioning

confidence: 99%

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The carbohydrate content of medications prescribed to children treated with a ketogenic diet

Sawangrit

Chomtho

Siritientong

2020

Pharmacy Practice and Res

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Background: Carbohydrate excipients include starches, dextrin, maltodextrin, sugar and sugar alcohols. No studies have investigated the cumulative daily carbohydrate content of medications prescribed to children with epilepsy receiving a ketogenic diet. Aims: To calculate carbohydrate contents in medications and the ketogenic ratio of children with intractable epilepsy. Methods: This retrospective study reviewed the ketogenic diet order forms of children with intractable epilepsy aged <18 years who were admitted to King Chulalongkorn Memorial Hospital, a tertiary referral teaching hospital in Thailand, from 2009 to 2017. All medications were obtained from cross-sectional medical records. The carbohydrate contents in medications were compiled by a hospital's database or requested from manufacturers. Overall carbohydrate contents in prescribed medications were calculated and included in grams of carbohydrate in ketogenic ratio. Results: A total of 169 ketogenic diet order forms of 38 epileptic patients were examined. One hundred and forty-five oral medications were prescribed, of which oral liquid medications had significantly higher carbohydrate content than solid oral dose forms (p < 0.001). Patients received a median of nine medications of which a median of four were anti-epileptic medications. The median carbohydrate content in medications was 0.99 g/day (IQR: 0.63-1.77 g/day). The significant difference of ketogenic fat:non-fat gram ratios was found when prescribed carbohydrate content in medications was higher than 2 g/day. Conclusions: Liquid medications had approximately eight times higher carbohydrate content than solid dosage forms. Comprehensive reviews of the carbohydrate content of medications and the possible association with seizure control should be performed to investigate the clinical significance of this finding.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The carbohydrate content of medications prescribed to children treated with a ketogenic diet

Sawangrit

Chomtho

Siritientong

2020

Pharmacy Practice and Res

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“…In IMD, underconcentrated feeds with inadequate energy and nutrient content may cause catabolism and subsequently metabolic instability and decompensation 5–9. Similarly, with a modular-based ketogenic feed, accurate administration of a high fat formula is vital in maintaining ketosis; any dietary fat loss could reduce efficacy of seizure control 10. Overconcentrated formula may cause electrolyte imbalance, diarrhoea, dehydration and ultimately malnutrition 1–3…”

Section: Introductionmentioning

confidence: 99%

Nutritional content of modular feeds: how accurate is feed production?

Evans

Daly

Ashmore

et al. 2013

Archives of Disease in Childhood

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“…The ketogenic ratio may be as high as 4:1 or 3:1 to get ketosis on seizure control. A 4 or 3:1 ketogenic ratio describes a KD that is made of 4 or 3 grams of fat for every 1 gram of non-fat nutrients (protein plus carbohydrate (6)(7)(8)(9). Normally, the daily energy intake distribution should be 55% carbohydrate, 30% protein, and 15% fat of total energy expenditure (10).…”

Section: List Of Abbreviationsmentioning

confidence: 99%

Carbohydrate content of the medications for epileptic children treated with ketogenic diet at King Chulalongkorn memorial hospital

Sawangrit

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The purposes of this study were to establish a database of the carbohydrate content of medications and investigate carbohydrate content of medications in epileptic children treated with ketogenic diet (KD) at King Chulalongkorn Memorial Hospital. One hundred sixty-nine KD order forms in 3 events (KD initiation, follow-up visit, and hospital re-admission) for epileptic children whose aged younger than 18 years old during 2009-2017 were selected. Clinical and nutritional data were obtained from medical records and KD order forms from the pediatric nutrition unit. The study showed that oral liquid dosage forms had the highest carbohydrate content in the formulations as 0.52 (0.13-1.78) g/dosage unit. In the event of hospital re-admission, children were at risk of excessively received carbohydrate content of medications because of the increased number of medications for treating illnesses. However, there was no significant difference between carbohydrate content in the prescribed diet and carbohydrate content in the prescribed diet plus carbohydrates from medications in 3 events (p>0.05). Likewise, the difference between fat: non-fat gram ratio in the prescribed diet and fat: non-fat gram ratio in the prescribed diet plus carbohydrates from medications in 3 events were not significant (p>0.05). The result showed that seizure frequency was positively correlated with number of anti-epileptic drugs (r=0.365, p=0.021). However, no significant correlation was found between seizure frequency and carbohydrate content in the diet as prescribed plus carbohydrates from medications (p=0.462). This study demonstrated that medications in oral liquid dosage forms contained high carbohydrate content which may impact ketosis status; therefore, such dosage forms should be avoided in epileptic children treated with KD. Children should be closely monitored urine ketone, serum ketone level, and seizure frequency.

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Ketogenic Diets

Cited by 4 publications

References 33 publications

The carbohydrate content of medications prescribed to children treated with a ketogenic diet

The carbohydrate content of medications prescribed to children treated with a ketogenic diet

Nutritional content of modular feeds: how accurate is feed production?

Carbohydrate content of the medications for epileptic children treated with ketogenic diet at King Chulalongkorn memorial hospital

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