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Acute pancreatitis causing death in a child on the ketogenic diet
W A Stewart1, K Gordon, P Camfield
1Department of Pediatrics, Dalhousie University, IWK Health Centre, Halifax, Nova Scotia. wastewar@is.dal.ca
Insights
The ketogenic diet, used for drug-resistant seizures in children, can rarely lead to severe complications like acute pancreatitis. This case highlights a fatal outcome, prompting further investigation into ketogenic diet risks.
Area of Science:
- Neurology
- Pediatrics
- Gastroenterology
Background:
- The ketogenic diet is an established therapy for pediatric epilepsy, particularly drug-resistant cases.
- While generally safe, potential complications require ongoing monitoring.
- Medium-chain triglyceride (MCT) oil is often used to enhance ketogenic diet efficacy.
Observation:
- A 9-year-old girl with a seizure disorder and developmental delay due to glucose transport protein deficiency was on a ketogenic diet since infancy.
- The patient presented with coma, respiratory distress, and shock, indicative of a critical medical event.
- Investigations revealed acute pancreatitis, leading to hypotension, acidosis, cardiac arrest, and death.
Findings:
- Postmortem examination confirmed hemorrhagic pancreatitis.
- Hypertriglyceridemia, a known risk factor for pancreatitis, is often associated with high-fat ketogenic diets.
- The patient's hyperlipidemia likely contributed to the development of acute pancreatitis.
Implications:
- This case underscores a rare but severe potential complication of the ketogenic diet in children.
- Further research is needed to identify risk factors and preventative strategies for ketogenic diet-induced pancreatitis.
- Clinicians should carefully consider the lipid profile and potential risks when prescribing ketogenic diets for pediatric patients.
Abstract:
The ketogenic diet has demonstrated good efficacy in children with pharmacologically resistant seizures. Relatively few serious complications have been reported in the more than 70 years in which the diet has been used. We report a child who developed acute pancreatitis and died. A 9-year-old girl had a seizure disorder with associated developmental delay owing to glucose transport protein deficiency. The ketogenic diet with medium chain triglyceride oil had been initiated shortly after diagnosis in infancy. She was not on anticonvulsants. She presented in coma with decreased respiratory effort and shock, requiring resuscitation. Investigations were consistent with pancreatitis. Despite fluid resuscitation and inotropic support, she had prolonged hypotension and acidosis. She subsequently had a cardiac arrest and died. A postmortem examination confirmed hemorrhagic pancreatitis. Hypertriglyceridemia is a risk factor for developing acute pancreatitis. The high fat content of the ketogenic diet often causes hyperlipidemia. The outcome for this patient raises concern regarding a potential consequence of the ketogenic diet.