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Objective  Due to the possibility of serious adverse events (AE), patients are commonly admitted to hospital for 3‐5 days for ketogenic diet (KD) initiation. This study examined the incidence of potential AE during admission for KD initiation to investigate the possibility of safely initiating a KD at home.    Methods  Children with drug‐resistant epilepsy (DRE) who were admitted to hospital for 5 days for KD initiation were retrospectively studied.    Results  A total of 66 children (59% female) were analyzed. The mean age at the initiation of the KD was 48.0 ± 38.4 months, and the mean weight was 14.6 ± 6.3 kg. The median number of anticonvulsant medications used at the time of KD initiation was 3. The etiology of the DRE was structural in 4.5%, hypoxic ischemic encephalopathy in 10.6%, genetic/metabolic in 31.8%, acquired in 10.6%, and unknown in 42.2%. The potential AE occurred in 28.7% of patients, including hypoglycemia (20%), hypoactivity (6.1%), somnolence (3%), and vomiting (7.6%). A univariate analysis of the clinical characteristics of the AE and no AE groups showed a statistically significant difference in weight ( P  = 0.003) and age ( P  = 0.033). The concurrent use of topiramate was found to have a near‐significant association ( P  = 0.097) between the groups. The groups' urine ketone levels on all 5 days were compared, and a statistically significant difference was found on day 3 ( P  = 0.026). A statistically significant difference in the serum bicarbonate levels ( P  = 0.038) was found between the patients taking topiramate and those not taking it.    Significance  The incidence of AE during admission for KD initiation was found to be low. The AE either required no intervention or were easily managed with simple interventions. Thus, in carefully selected patients, it may be possible to initiate a KD at home if the parents are adequately prepared and monitored.

Incidence of potential adverse events during hospital‐based ketogenic diet initiation among children with drug‐resistant epilepsy