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Optimal clinical management of children receiving ketogenic parenteral nutrition: a clinical practice guide
Author(s) -
Louw Elles,
Aldaz Vanessa,
Harvey Jessica,
Roan Marian,
Hurk Dorine,
Cross J Helen,
Auvin Stéphane
Publication year - 2020
Publication title -
developmental medicine and child neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.658
H-Index - 143
eISSN - 1469-8749
pISSN - 0012-1622
DOI - 10.1111/dmcn.14306
Subject(s) - parenteral nutrition , medicine , ketogenic diet , clinical nutrition , enteral administration , hepatology , intensive care medicine , intensive care unit , pediatrics , epilepsy , psychiatry
Aim To give evidence‐based recommendations on the application of ketogenic diet parenteral nutrition ( KD ‐ PN ) in emergency situations. Method An international group of experts ( n =14) researched the literature and distributed a survey among 150 expert centers. International accepted guidelines (European Society for Clinical Nutrition and Metabolism/European Society for Paediatric Gastroenterology Hepatology and Nutrition and the American Society for Parenteral and Enteral Nutrition) and handbooks for parenteral nutrition were considered general standards of care. Results In the literature, we identified 35 reports of patients treated by KD ‐ PN . International guidelines and handbooks provided some conflicting information. Twenty‐four expert teams from nine countries responded to the survey, reflecting the limited clinical experience. Interpretation This paper highlights 23 consensus‐based recommendations for safe and effective KD ‐ PN (e.g. diet initiation, calculation, application, monitoring, and evaluation) based on the best evidence available and expert opinions. What this paper adds In acute settings, ketogenic diet therapy (KDT) can be administered parenterally. Parenteral administration of KDT should be started only at the intensive care unit. Initiate ketogenic parenteral nutrition stepwise to the highest ratio possible with the lowest level of complications. Evaluate the risk–benefit ratio of parenteral administration continuously. Restart enteral feeding as soon as appropriate.