Nutrition Interventions for Children with Special Health Care Needs

Chapter 22 - Ketogenic Diet for Seizure Disorders
Assessment Intervention Evaluation/Outcome
Albumin, Prealbumin If albumin is low, increase protein intake. Albumin levels within normal limits.
• MD to determine if decrease in
anticonvulsants is indicated
AED (antiepileptic medication) levels Some anticonvulsants can have an increase in medication level when
a state of ketosis is present.
Normal AST and ALT levels
Fat absorption/metabolism may be decreased in liver disease - KD
can alter liver function due to high load of fat
Aspartate aminotransferase (AST)
• High AST and ALT may indicate the need to
• decrease ratio
Alanine aminotransferase (ALT)
• Maintain normal hematocrit and
hemoglobin.
• Maintain adequate hydration,
based on fluid needs in mLs per
kilogram
Complete blood count Close physician supervision is necessary to evaluate.
• Provide iron supplement if anemic.
• Elevated hemoglobin and hematocrit may indicate fluid
deficit; obtain fluid intake history, tease out possible causes,
recommend/re-teach family as appropriate
• AM Ketones: consistent level,
individualized for each child
• PM Ketones: consistent level,
individualized for each child
• Discontinue once child has
stabilized on the diet
• Can be useful to check for
hyperketosis, and to check the
effects of foods eaten that are
not allowed on the diet (lower
ketosis than usual).
Ideally, urine ketones should be checked every morning and
afternoon. If ketones are checked just once per day, then afternoon
or evening is necessary. Caregivers should log ketone levels daily
along with seizure activity to help evaluate the success of the diet.
Urine ketone levels
• Checked at same time twice
daily, useful at the beginning of
the diet.
• After initial start, only a good
indicator of dehydration or
hyperketosis in the context of
decreased oral intake of fluids or
food.
252 Nutrition Interventions for Children With Special Health Care Needs
Consistent range depending on
child’s response to the KD.
Betahydroxybutyric Acid
Large ketone body found in serum,
considered the most reliable method
for determining level of ketosis