title: Ketogenic diet: rapid onset of selenium deficiency-induced cardiac decompensation.
abstract: Selenium-deficiency cardiomyopathy is a known secondary complication from long-term treatment with a ketogenic diet for medical refractory epilepsy. Our patient, a 5-year-old boy on a ketogenic diet for intractable seizures, had a normal selenium level before starting the diet, but he shortly thereafter developed acute reversible cardiomyopathy and ventricular tachycardia, which was unmasked during a hospitalization for an elective operative procedure. His cardiomyopathy was suspected to be secondary to a selenium-deficient state and was confirmed by way of a markedly low serum selenium level and supported by rapid improvement with the initiation of selenium supplementation and cessation of the ketogenic diet. For patients being initiated on a ketogenic diet, current screening guidelines call for baseline and follow-up selenium levels every 3 months during the first year along with RDA selenium supplementation, which is 30 mcg/day. Most of the new ketogenic diet formulas meet this requirement. Our patient underwent elective surgery before his planned 3-month selenium level check and had potentially preventable complications. Secondary to this experience, we suggest that all patients initiated on a ketogenic diet should have a preoperative electrocardiogram (EKG), an echocardiogram, and selenium level determined before any elective surgery. These steps would prevent unnecessary perioperative morbidity and mortality.
authors.affiliation: Department of Pediatrics, West Virginia University School of Medicine, 1 Medical Center Drive, Morgantown, WV 26506, USA. nsirikonda@hsc.wvu.edu
authors.forename: Naga S
authors.initials: NS
authors.lastname: Sirikonda
authors.forename: William D
authors.initials: WD
authors.lastname: Patten
authors.forename: John R
authors.initials: JR
authors.lastname: Phillips
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Mullett
mesh_terms: D009202:Cardiomyopathies / Q000209:etiology*; D002675:Child, Preschool; D055423:Diet, Ketogenic / Q000009:adverse effects*; D004562:Electrocardiography; D004827:Epilepsy / Q000178:diet therapy*; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D012643:Selenium / Q000172:deficiency*
chemical_list: D012643:Selenium