Abstract

Introduction: Recommendations for children with severe altered states of consciousness does not include ketogenic nutrition. The purpose of this study was to evaluate short-term quality control outcomes for a ketogenic diet in this population, document challenges, and guide next steps.

Methods: We performed a 19-month descriptive cohort study that included children, <17 years of age, admitted to the pediatric intensive care unit. Short-term quality control outcomes included increase in beta-hydroxybutyrate, number of episodes of blood glucose levels below 4 mmol/L, development of acidosis (pH < 7.3), and clinical development of kidney stones.

Results: Thirteen patients with stroke, traumatic brain injury or hypoxic ischemic encephalopathy were evaluated. The average beta-hydroxybutyrate level was 1.7 mmol/L, one patient (8%) developed hypoglycemia, seven patients (54%) developed acidosis, and no kidney stones were documented. Initiation of enteral nutrition was delayed, and the average protein intake was 0.58 g/kg.

Conclusion: Modifications to our ketogenic protocol included changes to the ketogenic ratio, and earlier wean to optimize protein, and the goal of positive ketones from both serum and urine testing only.

Keywords: Acute brain injuries; Children; Enteral formulas; Ketogenic diet; Intensive care

Abbreviations: ASC: Altered States of Consciousness; BHB: Beta-Hydroxy Butyrate; GCS: Glasgow Coma Scale; HIE: Hypoxic Ischemic Encephalopathy; PICU: Pediatric Intensive Care Unit; REE: Resting Energy Expenditure; TBI: Traumatic Brain Injury