Abstracts

Rationale: Patients on the ketogenic diet for treatment of epilepsy or metabolic disorders are required to follow strict guidelines outlined with a provider in an Epilepsy subspecialty clinic that initiates and manages diet therapy. In some cases, a break in ketosis can lead to an acute seizure exacerbation or status epilepticus. Mismanagement due to knowledge deficit can lead to progressive acidosis and other electrolyte imbalances along with dehydration and seizure risk. Providing patients and caregivers with a specific, standardized Emergency Guide is an important tool for medical providers outside of a epilepsy specialty clinic to maintain optimal management of this medical diet. Providing guidelines may prevent inadvertent breaks in ketosis that could lead to exacerbation of seizures. Methods: Families experience challenges in maintaining ketosis when their child is treated outside of a ketogenic diet center. Preventable breaks in ketosis, hypoglycemia and dehydration were identified. In order to mitigate this avoidable risk, a wallet sized reference card was produced for the purpose of sharing guidelines with health care providers unfamiliar with ketogenic diet management, particularly in the acute setting (ie: emergency room, urgent care). The ketogenic diet requires specialized knowledge not always available in the community. Providers that do not regularly manage the diet, (ie., EMS or Emergency Department physicians) often require guidance in selecting compatible fluids, medications and products, particularly in the setting of acidosis and hypoglycemia. Results: This card was provided to patients and caregivers with the recommendation to be carried on their person in preparation of acute events. This guideline provides a basic description of the diet and treatment protocols currently in practice for these individuals. Cards include information on limiting total carbohydrate exposure (ie., glucose, dextrose, and sucrose-containing products), acceptable IV/enteral fluid choices, management of acidosis, and fasting guidelines. This Emergency Card is provided to epilepsy patients at the time of ketogenic diet initiation and/or at ketogenic clinic visits. In addition, this card contains contact information for the patient’s ketogenic diet clinicians for questions or further assistance in care planning. Conclusions: The information on the card provides appropriate treatment recommendations for unforeseen emergency situations including dehydration, acidosis, and hypoglycemia along with contact information for the patient’s providers. Sharing this project in order to elicit feedback from other centers and compare strategies for safe crisis management. A formal survey of families and health care providers is planned to assess the benefits of this tool. Funding: No funding