Pediatric emergency department visit characteristics of the patients on the ketogenic diet

Background: The ketogenic diet (KD) has been frequently used for the patientswith drug-resistant epilepsy in recent years. The management of these patients in emergency departments (EDs) has some difficulties due to the special needs of KD. We aimed to determine the characteristics and themanagement of the patients on the KD in the pediatric ED setting. Methods: Patientswhowere on the KD and admitted to the ED were included in the study. Demographic, clinical, and laboratory data of all patients were retrospectively reviewed and recorded. Results: Therewere 105 emergency admissions of 27 patients. Themedian age of all patientswas 55.0 (IQR: 29.091.0) months. The most common symptom was vomiting (43.8%). Four patients had upper gastrointestinal bleeding, and one patient had hyperammonemic acute hepatic failure while receiving KD. Of the patients, 41.9% had seizure-related ED admission. Infectionswere present in 41.9% of the ED visits. The frequency of status epilepticus was significantly lower in the patients who were on the KD for more than 6 months (p b 0.01). In 42.9% of all ED admissions, dextrose containing maintenance fluids was administered mistakenly; although ketosis rate was lower, no seizure was observed in this group. Conclusion: The patients on the KD can be admitted to EDswith intercurrent illnesses or adverse effects of the KD. For accurate management, emergency physicians must be aware of the common reasons for ED admission of these patients and the effects of the KD. (c) 2019 Elsevier Inc. All rights reserved.