Abstracts

Rationale: Ketogenic Diet (KD) is being increasingly used in neuro-critical care units for refractory status epilepticus (RSE), both in adults and children. After the opening of a dedicated pediatric neuro-critical care unit at our institution in May 2018 (the only unit of its kind in the nation), emphasis was placed on starting KD not just in patients with RSE but also in patients with Acute Repetitive Seizures (ARS) not meeting criteria for SE but needing ICU admission. We present data on 6 such patients in whom KD was started in the ICU for the above indications. Methods: Six patients were identified from May 2018 to May 2019 who were started on KD in the ICU for RSE or ARS. Primary outcomes were achieving ketosis (defined as serum beta-hydroxybutyrate levels >2 mmol/l) and resolution of status epilepticus and/ or >50% reduction in ARS. Results: Six patients ranged in age from 5 months to 15 years. Three patients had RSE and 3 patients had ARS (although 1 of them had RSE on initial presentation which had resolved). Time to start the diet ranged from 10 days to 4 weeks for patients in RSE and 4 weeks to 6 weeks for patients with ARS. KD ratios ranged from 3:1 to 4:1. Adequate ketosis was achieved in 5 out of 6 patients. The 6th patient was an infant on steroids due to adrenal insufficiency, which may explain low ketones. KD was successful in achieving primary outcomes in all patients. However, one patient with ARS later expired due to withdrawal of care from respiratory issues due to underlying condition but achieved primary seizure outcome.Initial hurdles to timely initiation of the diet were identified as delay in initial consultation, delay in converting medications to low carbohydrate forms and delay in sending and reporting of pre-initiation labs to rule out absolute contraindications. A comprehensive inpatient KD team was instituted comprising of physician (epileptologist), ketogenic dietitian, neuro-phramacist and nurse coordinator, which resulted in early identification and faster initiation of KD. Conclusions: KD is an effective treatment for management of seizures in the pediatric neuro-critical care unit (both RSE and ARS not meeting criteria for SE) and should be considered early in such patients. A standardized approach with a comprehensive inpatient KD team should be considered to meet the needs of busy pediatric neuro-critical care units. Funding: No funding