Aim The National Institute for Health and Care Excellence (NICE) states that initiation of a ketogenic diet should be considered for children and young people whose epilepsy has not responded to anti-epileptic drug therapy.¹ At present, no guideline exists within the Trust about ketogenic diets and so it was agreed that some guidance would be appropriate to guide doctors, nursing staff and pharmacists about how to manage medication for paediatric patients on a ketogenic diet.

Method A literature search was conducted using Embase and Medline with the search terms ‘ketogenic diet’ and ‘epilepsy.’ The only filters included in the search were to ensure information was in English and that human subjects were the focus. Guidance used within other Trusts and recommendations from the International Ketogenic Diet Study group were also considered.There is a paediatric ketogenic dietician within the Trust and so she was consulted for her advice throughout guideline development.

Results A guideline has been produced that addresses how medicines should be managed for patients on a ketogenic diet. If any new medicines are initiated within hospital, practical advice is given on how to ensure the carbohydrate content is minimal, and the importance of ensuring ketone levels are monitored.

The guideline also briefly considers the acute and chronic effects of the ketogenic diet and how these may result in other medicines and supplements being prescribed. Given that there is no nationally recognised resource available for identifying the carbohydrate contents of medicines, all oral anti-epileptic medication, analgesics and antibiotics that could be used within the Children’s Hospital were considered and the carbohydrate contents confirmed with the relevant manufacturers, with the aim of guiding prescribing decisions about the management of pain, infections and epilepsy.

Despite many liquid medicinal preparations stating that they are ‘sugar free,’ they will often contain large amounts of sorbitol and other ingredients that are sources of carbohydrate, which will be problematic for ketogenic diet patients.² Given that liquid preparations are largely used within the Children’s Hospital, the guideline gives practical advice about key sources of carbohydrate that may be found in liquid medicines and hence ingredients that should be avoided where possible.

Conclusion The research conducted to develop this guideline has shown that ketogenic diets can be a very effective method for reducing seizure activity.² Considering that the carbohydrate content of medication can affect whether a patient is in a state of ketosis, it is important for healthcare professionals to acknowledge how to manage any changes to a patient’s medication. It is hoped that by providing the carbohydrate content of certain medicines within the guideline, patients will be treated in hospital without ketone levels being compromised.

References

1. National Institute for Health and Care Excellence. Epilepsies: Diagnosis and management (CG137). Available from: https://www.nice.org.uk/guidance/cg137/resources/epilepsies-diagnosis-and-management-35109515407813 [Accessed: 4th July 2016].

2. Great Ormond Street Hospital NHS Trust for Children. Ketogenic diet. Available from: http://www.gosh.nhs.uk/health-professionals/clinical-guidelines/ketogenic-diet [Accessed: 5th July 2016].