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Early- and Late-onset Complications of the Ketogenic Diet for Intractable Epilepsy

 Hoon Chul Kang  ;  Da Eun Chung  ;  Heung Dong Kim  ;  Dong Wook Kim 
 EPILEPSIA, Vol.45(9) : 1116-1123, 2004 
Journal Title
Issue Date
Adolescent ; Adult ; Anticonvulsants/adverse effects ; Anticonvulsants/therapeutic use ; Child ; Child, Preschool ; Combined Modality Therapy ; Dehydration/etiology ; Dietary Carbohydrates/administration & dosage ; Dietary Fats/administration & dosage* ; Dietary Fats/adverse effects* ; Dietary Fats/metabolism ; Dietary Proteins/administration & dosage ; Epilepsy/diet therapy* ; Epilepsy/drug therapy ; Epilepsy/metabolism ; Female ; Food, Formulated/adverse effects ; Humans ; Infant ; Ketones/metabolism ; Ketosis/complications* ; Ketosis/etiology ; Ketosis/metabolism ; Male ; Survival Analysis
Early onset ; Late onset ; Complications ; Ketogenic diet ; Intractable epilepsy
PURPOSE: This study was undertaken to evaluate the exact limitations of the ketogenic diet (KD) and to collect data on the prevention and management of its risks. METHODS: Patients (129) who were on the KD from July 1995 to October 2001 at our epilepsy center were assessed in the study. Early-onset (within 4 weeks of the commencement of the KD until stabilization) and late-onset complications (occurring after 4 weeks) were reviewed. RESULTS: The most common early-onset complication was dehydration, especially in patients who started the KD with initial fasting. Gastrointestinal (GI) disturbances, such as nausea/vomiting, diarrhea, and constipation, also were frequently noted, sometimes associated with gastritis and fat intolerance. Other early-onset complications, in order of frequency, were hypertriglyceridemia, transient hyperuricemia, hypercholesterolemia, various infectious diseases, symptomatic hypoglycemia, hypoproteinemia, hypomagnesemia, repetitive hyponatremia, low concentrations of high-density lipoprotein, lipoid pneumonia due to aspiration, hepatitis, acute pancreatitis, and persistent metabolic acidosis. Late-onset complications also included osteopenia, renal stones, cardiomyopathy, secondary hypocarnitinemia, and iron-deficiency anemia. Most early- and late-onset complications were transient and successfully managed by careful follow-up and conservative strategies. However, 22 (17.1%) patients ceased the KD because of various kinds of serious complications, and four (3.1%) patients died during the KD, two of sepsis, one of cardiomyopathy, and one of lipoid pneumonia. CONCLUSIONS: Most complications of the KD are transient and can be managed easily with various conservative treatments. However, life-threatening complications should be monitored closely during follow-up.
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1. College of Medicine (의과대학) > Dept. of Pediatrics (소아과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Hoon Chul(강훈철) ORCID logo https://orcid.org/0000-0002-3659-8847
Kim, Heung Dong(김흥동) ORCID logo https://orcid.org/0000-0002-8031-7336
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