Complications of the Ketogenic Diet

Authors

  • Karen Ballaban-Gil,

    Corresponding author
    1. Comprehensive Epilepsy Management Center, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York, U.S.A.
    2. Departments of Neurology, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York, U.S.A.
    3. Departments of Pediatrics, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York, U.S.A.
      Address correspondence and reprint requests to Dr. K. Ballaban-Gil at Epilepsy Management Center, Montefiore Medical Center, III E. 210th St., Bronx, NY 10467–2490, U.S.A.
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  • C. Callahan,

    1. Comprehensive Epilepsy Management Center, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York, U.S.A.
    2. Departments of Neurology, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York, U.S.A.
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  • C. O'Dell,

    1. Comprehensive Epilepsy Management Center, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York, U.S.A.
    2. Departments of Neurology, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York, U.S.A.
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  • M. Pappo,

    1. Departments of Nutrition, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York, U.S.A.
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  • S. Moshé,

    1. Comprehensive Epilepsy Management Center, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York, U.S.A.
    2. Departments of Neurology, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York, U.S.A.
    3. Departments of Pediatrics, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York, U.S.A.
    4. Departments of Neuroscience, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York, U.S.A.
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  • S. Shinnar

    1. Comprehensive Epilepsy Management Center, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York, U.S.A.
    2. Departments of Neurology, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York, U.S.A.
    3. Departments of Pediatrics, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York, U.S.A.
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  • Presented in part at the Annual Meeting of the Child Neurology Society, Minneapolis, Minnesota, September 26–28, 1996.

Address correspondence and reprint requests to Dr. K. Ballaban-Gil at Epilepsy Management Center, Montefiore Medical Center, III E. 210th St., Bronx, NY 10467–2490, U.S.A.

Abstract

Summary: Purpose: The ketogenic diet has been successfully used in treatment of pediatric epilepsy for >70 years. Few serious complications caused by the diet have been reported. We report complications that have been experienced by children receiving the ketogenic diet.

Methods: In a 22-month period, we treated 52 children with the classic ketogenic diet and monitored them in a prospective manner.

Results: Five children (10%) experienced serious adverse events (AE) after initiation of the diet. Four patients (80%) were treated with valproate (VPA) in addition to the diet, as compared with 25 (53%) of the other 47 children. Two patients developed severe hypoproteinemia within 4 weeks of initiation of the diet, and 1 of them also developed lipemia and hemolytic anemia. A third child developed Fanconi's renal tubular acidosis within 1 month of diet initiation. Two other children manifested marked increases in liver function tests, 1 during the initiation phase and the other 13 months later.

Conclusions: Clinicians who wish to use the ketogenic diet must be aware of the potential of serious AE and possible interactions of the diet with VPA.

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