Protein-losing enteropathy as a rare complication of the ketogenic diet.
BACKGROUND
The ketogenic diet is a valuable therapy for patients with intractable epilepsy, but it can result in a variety of complications that sometimes limits its usefulness. Hypoproteinemia is one of the common adverse effects of this diet, although the underling mechanism is largely unknown except for the diet's reduced protein intake. Only one case of protein-losing enteropathy during the ketogenic diet has been reported.


METHODS
A previously healthy 9-year-old girl experienced fever for 5 days then suddenly developed convulsive seizures that subsequently evolved to severe refractory status epilepticus. After multiple antiepileptic drugs failed to improve the patient's condition, we introduced the ketogenic diet. Although her seizures diminished, her course was complicated by hypoproteinemia. An abdominal dynamic scintigraphy and colonoscopy findings indicated protein-losing enteropathy with nonspecific mucosal inflammation. Her nutritional status deteriorated; thus, we discontinued the ketogenic diet. Her nutritional status gradually improved, whereas her seizures increased.


CONCLUSIONS
Hypoproteinemia during the ketogenic diet is common, but the underlying etiologies are not well understood. Abdominal dynamic scintigraphy could be valuable for clarifying the etiology of hypoproteinemia during the ketogenic diet.
Department of Neurology, Gunma Children's Medical Center, Gunma, Japan. Electronic address: medical-kengo@umin.ac.jp.
Kengo
K
Moriyama
Department of Neurology, Gunma Children's Medical Center, Gunma, Japan.
Mio
M
Watanabe
Department of Allergy and Immunology, Gunma Children's Medical Center, Gunma, Japan.
Yoshiyuki
Y
Yamada
Department of Neurology, Gunma Children's Medical Center, Gunma, Japan.
Takashi
T
Shiihara
D002648:Child; D055423:Diet, Ketogenic / Q000009:adverse effects*; D005260:Female; D006801:Humans; D011504:Protein-Losing Enteropathies / Q000209:etiology*; D013226:Status Epilepticus / Q000178:diet therapy*
99mTc-diethylene triamine pentaacetic acid human serum albumin; ketogenic diet; protein-losing enteropathy; scintigraphy