Conover et al recommended a number of steps be taken for managing a child on a ketogenic diet in the perioperative period. The authors are from Children's Hospital Colorado and University of Colorado.
Patient selection: ketogenic diet for drug-resistant epilepsy, metabolic or other disorder
Preoperative tasks:
(1) Consult with neurologist about the need to maintain the ketogenic diet and recommendations for anticonvulsant therapy.
(2) Avoid prolonged preoperative fasting (to avoid hypoglycemia).
(3) Determine baseline laboratory values: CBC, serum metabolic panel to include serum calcium and magnesium.
(4) Avoid medications or intravenous fluids that contain carbohydrates, including oral midazolam for preoperative sedation.
(5) Monitor preoperative fasting blood glucose on the day of surgery.
(6) Consider use of intranasal midazolam or dexmedetomidine for preoperative sedation.
Intraoperative management:
(1) Avoid medications or intravenous fluids that contain carbohydrates.
(2) Avoid using high doses of propofol for long periods.
(3) Use isotonic crystalloid solutions for volume replacement. Avoid large volumes of normal saline to reduce the risk of hyperchloremic metabolic acidosis.
(4) Monitor serum pH, serum glucose, serum electrolytes and serum bicarbonate if the patient is undergoing major surgery or surgery lasting more than 3 hours.
(5) If hypoglycemia occurs then avoid overcorrecting.
Postoperative management:
(1) Start the ketogenic diet as soon as permissible considering operative recovery.
(2) Consider monitoring urine and serum ketone concentrations.
(3) Monitor as inpatient or fast-track discharge as clinically indicated.
