Tabla. Manejo clínico de los efectos adversos durante la dieta cetogénica. |
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Monitorización clínica/laboratorio |
Manejo clínico |
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Vómitos |
Controles de cetonemia y cetonuria |
Zumo de naranja, hidratación vía oral/endovenosa, sales de rehidratación oral |
Acidosis metabólica |
Control medio interno a la semana, al mes y cada tres meses |
Hidratación, citrato de potasio, disminución de la ratio cetogénica, bicarbonato sódico |
Hipoglucemia |
Controles de glucemia capilar preprandiales |
Corrección con zumo de naranja (20 mL) |
Hiperlipidemia |
Control del perfil lipídico cada tres meses |
Cambiar el tipo de grasas, aumentar los aceites, disminuir las grasas saturadas, reducir el colesterol, agregar omega-3, considerar la disminución de la ratio cetogénica |
Enfermedad cardiovascular |
Dosis de selenio plasmático previo y cada 3-6 meses |
Suplementación adicional con selenio, controles de niveles plasmáticos |
Gastrointestinales |
Reflujo gastroesofágico Estreñimiento Dolor abdominal Hígado graso Pancreatitis |
Bloqueantes H2 Inhibidores de la bomba de protones Aumentar líquidos, agregar fibra, vaselina líquida, laxantes sin carbohidratos Laboratorio con hepatograma, amilasa, lipasa, trigliceridemia |
Nefrolitiasis |
Monitorización de la cetonuria Calcio/creatinina urinaria cada 3-6 meses Ecografía abdominal Análisis de orina completo |
Aumentar la hidratación Citratos para alcalinizar la orina |
Déficits de vitaminas, minerales y oligoelementos |
Multivitamínicos específicos para la dieta cetogénica sin carbohidratos |
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Salud ósea |
Absorciometría dual por rayos X Radiografía de edad ósea |
Suplemento de calcio, vitamina D |
Infecciones, neutropenia |
Hemograma con frotis neutrófilos |
Ver la dosis de cobre |
Alteración del crecimiento |
Factor de crecimiento insulínico de tipo 1 |
Ajuste de la ratio proteínas/calorías, disminución de la ratio cetogénica, ajuste calórico |
Update on the adverse effects during therapy with a ketogenic diet in paediatric refractory epilepsy Introduction. The ketogenic diet is a non-pharmacological treatment that has been used as a therapeutic alternative for the management of refractory epilepsy since 1921. It is a diet, high in fats and low in carbohydrates, which is used to treat paediatric refractory epilepsy, and is effective in around 50% of the patients that begin to follow it. It is a nutrition plan that is imbalanced in terms of both macro- and micro-nutrients, which can give rise to nutritional deficits in energy, proteins, minerals and vitamins, as well as an excess of lipids. There is therefore a risk of it causing undesirable side effects both at the outset and in later stages of the treatment. Development. The most frequent adverse effects that may occur either in acute form or in later stages are described, and tools that can be used in their management and prevention during treatment are proposed for paediatricians and ketogenic diet teams. Conclusions. Some adverse effects are difficult to interpret and may manifest due to involvement at different levels of the organism, thereby arousing doubts as to whether they are caused by the diet, the antiepileptic medication or by the patient’s own intercurrent complications. It is important to follow the study and evaluation frequency protocol in order to detect and prevent these effects, as well as to consult reference centres in order to evaluate the cost-benefit of continuing the treatment or not. Key words. Adverse effects. Clinical management. Complications. Ketogenic diet. Refractory epilepsy. |