Complications of the ketogenic diet.
OBJECTIVE
The ketogenic diet has been successfully used in treatment of pediatric epilepsy for >70 years. Few serious complications caused by the diet have been reported. We report complications that have been experienced by children receiving the ketogenic diet.


METHODS
In a 22-month period, we treated 52 children with the classic ketogenic diet and monitored them in a prospective manner.


RESULTS
Five children (10%) experienced serious adverse events (AE) after initiation of the diet. Four patients (80%) were treated with valproate (VPA) in addition to the diet, as compared with 25 (53%) of the other 47 children. Two patients developed severe hypoproteinemia within 4 weeks of initiation of the diet, and 1 of them also developed lipemia and hemolytic anemia. A third child developed Fanconi's renal tubular acidosis within 1 month of diet initiation. Two other children manifested marked increases in liver function tests, 1 during the initiation phase and the other 13 months later.


CONCLUSIONS
Clinicians who wish to use the ketogenic diet must be aware of the potential of serious AE and possible interactions of the diet with VPA.
Comprehensive Epilepsy Management Center, and Department of Neurology, Albert Einstein College of Medicine, Bronx, New York 10467-2490, USA.
K
K
Ballaban-Gil
C
C
Callahan
C
C
O'Dell
M
M
Pappo
S
S
Moshé
S
S
Shinnar
D000293:Adolescent; D002331:Carnitine / Q000172:deficiency; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004827:Epilepsy / Q000178:diet therapy* / Q000188:drug therapy; D005500:Follow-Up Studies; D005526:Food, Formulated / Q000009:adverse effects*; D006801:Humans; D007019:Hypoproteinemia / Q000209:etiology; D007223:Infant; D007662:Ketosis / Q000139:chemically induced*; D008107:Liver Diseases / Q000209:etiology; D008111:Liver Function Tests / Q000706:statistics & numerical data; D011446:Prospective Studies; D014635:Valproic Acid / Q000627:therapeutic use
D014635:Valproic Acid; D002331:Carnitine