Abstracts

Rationale: Ketogenic diet therapies have been shown to be an effective treatment for epilepsy in both children and adults. Current consensus guidelines recommend that lab work be completed prior to diet initiation, and then every three months during the first year on diet; this includes a complete blood count (CBC) with platelets. This study explores the incidence of neutropenia while adhering to one of the ketogenic diet therapies. Methods: A retrospective study was conducted on pediatric charts (age <22 years at time of initiation) from 2010-2019. N=129 charts were screened for having been seen by a Registered Dietitian in the outpatient epilepsy clinic. After the initial screen, further charts were excluded as there was unclear documentation that they had ever started dietary therapy (N=50). Individuals from this center were either on the classic ketogenic diet, the Modified Atkins diet, or the low glycemic index diet, with varying levels of compliance. In total, 79 charts were reviewed for CBC results and additional lab trends. Results: Out of the 79 pediatric patients who started on one of the ketogenic diet therapies, 12 patients were found to be leukopenic after diet initiation (15[DS1] % of sample population). Eleven out of the 12 patients had a pre-diet CBC available for comparison. All patients with available pre-diet bloodwork were noted to have a decrease in leukocytes after diet initiation. None of the patients who developed leukopenia required extra precautions or changes in management. All 6 out of 12 patients who have been since weaned off diet have had improvement/normalization of lab values.  Conclusions: Routine lab work remains a key component of ketogenic diet monitoring. The population studied showed that 15% of patients demonstrated leukopenia as a direct result of the ketogenic diet. The development of leukopenia after diet initiation may lead to further testing and medical follow-up that does not necessarily warrant medical intervention. Further review of current practice guidelines is needed to determine the cost/benefit analysis of specific laboratory panels if no intervention is performed.  Funding: No funding