Cardiopulmonary bypass considerations for pediatric patients on the ketogenic diet

Area of Science:

• Pediatric Cardiology
• Neurology
• Metabolic Disorders

Background:

• Intractable epilepsy in children often necessitates alternative treatments like the ketogenic diet.
• The ketogenic diet, a high-fat, low-carbohydrate regimen, is effective in reducing seizure frequency.
• Children on ketogenic diets undergoing cardiopulmonary bypass (CPB) require specialized protocols to avoid glucose exposure and maintain ketosis.

Observation:

• A 2-year-old male with intractable epilepsy and congenital heart disease underwent cardiac surgery.
• The surgical team implemented modified protocols, minimizing carbohydrate-containing medications.
• Metabolic monitoring was crucial to ensure the patient's ketosis was maintained throughout the procedure.

Findings:

• Successful cardiac surgery was performed on a pediatric patient maintained on a ketogenic diet.
• Adherence to modified protocols and vigilant metabolic monitoring prevented alterations in ketosis.
• The case demonstrates the feasibility of managing ketogenic diet patients during CPB.

Implications:

• Cardiac surgical teams must be aware of ketogenic diet patients and adapt protocols accordingly.
• Multidisciplinary collaboration is key for optimizing care, including modified CPB prime components and cardiac pharmacology.
• Advanced monitoring techniques like thromboelastography, electroencephalography, and continuous glucose monitoring are recommended for this patient population.