Department of Pediatric Emergency Care, Dr. Behçet Uz Children's Hospital, İzmir, Turkey..
Department of Pediatric Neurology, Dr. Behçet Uz Children's Hospital, İzmir, Turkey.
Epilepsy Behav. 2019 Oct;99:106446. doi: 10.1016/j.yebeh.2019.106446. Epub 2019 Aug 6.
The ketogenic diet (KD) has been frequently used for the patients with drug-resistant epilepsy in recent years. The management of these patients in emergency departments (EDs) has some difficulties due to the special needs of KD. We aimed to determine the characteristics and the management of the patients on the KD in the pediatric ED setting.
Patients who were on the KD and admitted to the ED were included in the study. Demographic, clinical, and laboratory data of all patients were retrospectively reviewed and recorded.
There were 105 emergency admissions of 27 patients. The median age of all patients was 55.0 (IQR: 29.0-91.0) months. The most common symptom was vomiting (43.8%). Four patients had upper gastrointestinal bleeding, and one patient had hyperammonemic acute hepatic failure while receiving KD. Of the patients, 41.9% had seizure-related ED admission. Infections were present in 41.9% of the ED visits. The frequency of status epilepticus was significantly lower in the patients who were on the KD for more than 6 months (p < 0.01). In 42.9% of all ED admissions, dextrose containing maintenance fluids was administered mistakenly; although ketosis rate was lower, no seizure was observed in this group.
The patients on the KD can be admitted to EDs with intercurrent illnesses or adverse effects of the KD. For accurate management, emergency physicians must be aware of the common reasons for ED admission of these patients and the effects of the KD.
近年来， ketogenic 饮食（KD）已被频繁用于治疗耐药性癫痫患者。由于 KD 的特殊需求，这些患者在急诊科（ED）的管理存在一些困难。我们旨在确定儿科 ED 环境中接受 KD 治疗患者的特征和管理方法。
纳入在 ED 接受 KD 的患者。回顾性分析并记录所有患者的人口统计学、临床和实验室数据。
共有 27 名患者的 105 次 ED 就诊。所有患者的中位年龄为 55.0（IQR：29.0-91.0）个月。最常见的症状是呕吐（43.8%）。4 名患者出现上消化道出血，1 名患者在接受 KD 时出现高氨血症性急性肝衰竭。41.9%的患者因癫痫相关而就诊 ED。感染在 41.9%的 ED 就诊中存在。在 KD 治疗超过 6 个月的患者中，癫痫持续状态的频率明显降低（p<0.01）。在所有 ED 就诊中，42.9%的患者错误地给予了含有葡萄糖的维持液；尽管酮症发生率较低，但该组患者未出现癫痫发作。
患有 KD 的患者可能因并发疾病或 KD 的不良反应而就诊 ED。为了进行准确的管理，急诊医师必须了解这些患者就诊 ED 的常见原因和 KD 的作用。
