Carbohydrate content of the medications for epileptic children treated with ketogenic diet at King Chulalongkorn memorial hospital

Abstract

The purposes of this study were to establish a database of the carbohydrate content of medications and investigate carbohydrate content of medications in epileptic children treated with ketogenic diet (KD) at King Chulalongkorn Memorial Hospital. One hundred sixty-nine KD order forms in 3 events (KD initiation, follow-up visit, and hospital re-admission) for epileptic children whose aged younger than 18 years old during 2009-2017 were selected. Clinical and nutritional data were obtained from medical records and KD order forms from the pediatric nutrition unit. The study showed that oral liquid dosage forms had the highest carbohydrate content in the formulations as 0.52 (0.13-1.78) g/dosage unit. In the event of hospital re-admission, children were at risk of excessively received carbohydrate content of medications because of the increased number of medications for treating illnesses. However, there was no significant difference between carbohydrate content in the prescribed diet and carbohydrate content in the prescribed diet plus carbohydrates from medications in 3 events (p>0.05). Likewise, the difference between fat: non-fat gram ratio in the prescribed diet and fat: non-fat gram ratio in the prescribed diet plus carbohydrates from medications in 3 events were not significant (p>0.05). The result showed that seizure frequency was positively correlated with number of anti-epileptic drugs (r=0.365, p=0.021). However, no significant correlation was found between seizure frequency and carbohydrate content in the diet as prescribed plus carbohydrates from medications (p=0.462). This study demonstrated that medications in oral liquid dosage forms contained high carbohydrate content which may impact ketosis status; therefore, such dosage forms should be avoided in epileptic children treated with KD. Children should be closely monitored urine ketone, serum ketone level, and seizure frequency.