Abstracts

Rationale: With an epilepsy prevalence of 1%, literature suggests that about 35% of patients with epilepsy have pharmacoresistance. Ketogenic diet (KD) has been successful in significantly improving seizure control, and quality of life in patients with drug resistant epilepsy. Acidosis is one of the potential side effects of the ketogenic diet. It has been customary in some epilepsy centers to start citrates, or bicarbonates prophylacticaly, to avoid that side effect. In this study, we try to evaluate the prevalence of acidosis as a side effect in patients taking KD, and assess the need for prophylaxis with Citrates and/or Bicarbonates to prevent that side effect.Methods: A prospective study of 73 patients of a total of 186 patients on a ketogenic diet for drug resistant epilepsy, in a level 4 pediatric epilepsy center were studied. Patients had Basic Metabolic Panel (BMP) including CO2 levels checked during the initiation phase, at 1 month, and every 3 months afterwards. A retrospective analysis of the data was done to study the occurrence of acidosis as a side effect in patients taking a ketogenic diet, and whether prophylactic administration of citrate, or bicarbonates started at initiation of the diet lessens the risk of acidosis A value of 15 mmol was the cutoff for determining acidosisResults: From the 73 patients, 17 had acidosis (CO2 level of 15 mmol/L or less), with 9 males, and 8 females. Age ranged between 2 months, and 16 years old. 5 patients (29.4%) developed acidosis within the first month of initiating the diet, and 12 developed acidosis between 3-24 months from initiation. Out of all patients developing acidosis, 7 required ongoing supplementation with Citrate or Bicarbonate. While the rest (10 patients) did not require ongoing supplementation treatment.Conclusions: Acidosis is one of the risks of the ketogenic diet. That can occur during any time after initiating the ketogenic diet. The incidence of acidosis is highest during the first month of initiating the diet. However prophylaxis with citrates, or bicarbonates might not be needed for all patients, since, the majority of patients’ acidosis did not require chronic prophylaxis.