Department of Nutrition and Dietetics, Alfred Hospital, Melbourne, Victoria, Australia.
Department of Allied Health (Clinical Nutrition), Royal Melbourne Hospital, Parkville, Victoria, Australia.
JPEN J Parenter Enteral Nutr. 2022 Nov;46(8):1819-1827. doi: 10.1002/jpen.2373. Epub 2022 Apr 7.
Induction of ketosis by manipulation of nutrition intake has been proposed as an adjunctive treatment for super-refractory status epilepticus (SRSE). However, the classical 4:1 ketogenic ratio may not meet the nutrition needs, specifically protein for critically ill adults. The aim of this study was to analyze the outcomes of adults with SRSE who received a lower ketogenic ratio of 2:1 grams of fat to non-fat grams, including 20%-30% of energy from medium chain triglycerides.
We reviewed patients aged ≥18 years with SRSE treated with ketogenic therapy between July 2015 and December 2020 at two quaternary teaching hospitals in Melbourne, Australia. Data collected from medical records included patient demographics, nutrition prescription, clinical outcomes, and ketogenic therapy-related complications. The primary outcome of the study was to assess tolerability of ketogenic therapy.
Twelve patients (female = 7) were treated with ketogenic therapy for SRSE. Patients received between 4 and 8 antiseizure medications and 1-5 anesthetic agents prior to commencement of ketogenic therapy. Blood beta-hydroxybutyrate concentrations were variable (median = 0.5 mmol/L, range: 0.0-6.1 mmol/L). SRSE resolved in 10 cases (83%) after a median of 9 days (range: 2-21 days) following commencement of ketogenic therapy. Ketogenic therapy-associated complications were reported in five patients, leading to cessation in two patients.
Despite the challenge in maintaining ketosis during critical illness, low ratio 2:1 ketogenic therapy incorporating medium chain triglycerides is tolerable for adults with SRSE. Further studies are required to determine the optimal timing, nutrition prescription and duration of ketogenic therapy for SRSE treatment.
通过营养摄入的调控诱导酮症已被提议作为治疗超难治性癫痫持续状态（SRSE）的辅助手段。然而，经典的 4:1 生酮比例可能无法满足营养需求，特别是对于重症成人的蛋白质需求。本研究旨在分析接受生酮比例为 2:1 克脂肪与非脂肪克，包括 20%-30%中链甘油三酯能量的成人 SRSE 患者的结局。
我们回顾了 2015 年 7 月至 2020 年 12 月期间在澳大利亚墨尔本的两家四级教学医院接受生酮治疗的年龄≥18 岁的 SRSE 患者。从病历中收集的数据包括患者人口统计学、营养处方、临床结局和生酮治疗相关并发症。该研究的主要结局是评估生酮治疗的耐受性。
12 名患者（女性=7）接受生酮治疗 SRSE。患者在开始生酮治疗前接受了 4 至 8 种抗癫痫药物和 1 至 5 种麻醉剂。血液β-羟丁酸浓度各不相同（中位数=0.5mmol/L，范围：0.0-6.1mmol/L）。在开始生酮治疗后中位 9 天（范围：2-21 天），10 例（83%）患者 SRSE 缓解。有 5 名患者报告了生酮治疗相关并发症，导致 2 名患者停止治疗。
尽管在危重病期间维持酮症存在挑战，但包含中链甘油三酯的低比例 2:1 生酮治疗对 SRSE 成人是可耐受的。需要进一步的研究来确定 SRSE 治疗中生酮治疗的最佳时机、营养处方和持续时间。
