Abstracts

Rationale: : The best indicator of level of ketosis continues to be debatable. In our program, we currently use correlation of both the acetoacetate in the urine ketones and the betahydroxybutyrate in the blood to assess ketosis during diet initiation. The purpose of this study is to determine a threshold for correlation of a certain betahydroxybutyrate level with a certain level of urine ketones and if this differs in those ages 2 and older and those under age 2. Anecdotally there is a difference noted in levels of betahydroxybutyrate achieved with large ketones during initiation in certain age groups. Methods: This is a retrospective chart review study from a level 4 epilepsy center. We have initiated a total of 148 patients on the ketogenic diet. The most recent 72 patients have been used for the purposes of this study and they were divided into those less than 2 years of age and age 2 and greater. Urine ketones and betahydroxybutyrate were reviewed for the 3-5 day diet initiation phase specifically looking at the BHBA when in large ketones.Results: Of our 72 patients reviewed, 36 were less than 2 and 36 were 2 or older at diet initiation. On average, the patients under 2 years of age had a betahydroxybutyrate of 4513 before reaching large urine ketones. Conversely, on average, the 2 years and older age group achieved large urine ketones at a much lower betahydroxybutyrate of 3234. When reviewing the data for negative and trace urine ketone measurements, the betahydroxybutyrate was found to be higher in the 2 years of age and older group.Conclusions: Upon analysis of the data, we can conclude that for patients 2 years of age and older knowing the urine ketones as reported by the family could be used to predict an estimate of the betahydroxybutyrate levels for future management of our patients. Incidentally the data also revealed that betahydroxybutyrate may not be the best measure of ketosis in that age group.