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Use of Parenteral Medium‐Chain Triglyceride Emulsion for Maintaining Seizure Control in a 5‐Year‐Old Girl with Intractable Diarrhea
Author(s) -
Rosenthal Elana,
Weissman Barbara,
Kyllonen Kay
Publication year - 1990
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1177/0148607190014005543
Subject(s) - parenteral nutrition , ketogenic diet , medicine , ketosis , diarrhea , enteral administration , medium chain triglyceride , short bowel syndrome , gastroenterology , triglyceride , regimen , endocrinology , epilepsy , cholesterol , diabetes mellitus , psychiatry
Medium‐chain triglycerides (MCT) are an important component of an enteral ketogenic diet for seizure control. Previously, it was difficult to maintain ketosis when parenteral (iv) nutrition therapy was necessary. The use of iv MCT in a 5‐year‐old girl with Lennox‐Gastaut syndrome who had diarrhea and dehydration is reported. Conventional 20% iv fat emulsion (long‐chain triglycerides, LCT) and dextrose free hyperalimentation (HAL) in a 4:1 ketogenic ratio did not maintain adequate ketosis during bowel rest. Compassionate use of iv MCT (Clintec Nutrition) infused as a 70:30 MCT/ LCT ratio plus HAL maintained moderate ketosis. Seizures were well controlled during the iv MCT regimen, which allowed normal daily functioning. Complications included abnormal liver function tests and severe iron deficiency anemia of unknown etiology. Serum triglyceride and cholesterol levels increased to 1717 mg/dl and 614 mg/dl, respectively, but decreased with a reduction of lipid infusion and use of an antihyperlipemic drug. Nutritional status was maintained. In this case, iv MCT proved to be a relatively safe and effective short‐term method of continuing parenteral nutrition while maintaining ketosis for seizure control. (Journal of Parenteral and Enteral Nutrition 14: 543–545, 1990)