Ketogenic Diet for Intensive Care Patients: A Scoping Review

Area of Science:

• Metabolic Disorders
• Intensive Care Medicine
• Nutritional Therapy

Background:

• Critical illness causes complex metabolic, neuroendocrine, and immune dysfunctions impacting patient outcomes in ICUs.
• The ketogenic diet (KD), characterized by high fat and low carbohydrate intake, is emerging as a potential metabolic intervention in critical care.
• Preliminary evidence suggests KD may help manage super-refractory epileptic states (SRSE), stabilize blood glucose, reduce insulin needs, and modulate immune responses in sepsis.

Purpose of the Study:

• To review the current knowledge on the application of the ketogenic diet (KD) in intensive care unit (ICU) patients.
• To synthesize findings on KD's efficacy and safety in critical care settings.

Main Methods:

• A systematic review adhering to Joanna Briggs Institute and PRISMA-ScR guidelines.
• Searched multiple databases (PubMed, Scopus, Web of Science, etc.) for studies on KD use in ICU patients (April 2026).
• Included full-text observational studies, randomized trials, and reviews; data extracted by two independent reviewers.

Main Results:

• Seven studies involving critically ill adults and children were analyzed, indicating KD is feasible and safe.
• In SRSE, KD facilitated stable ketosis, enabling anesthetic reduction/discontinuation.
• In sepsis, KD improved glycemic control, decreased insulin requirements, and reduced immune dysregulation, with one study reporting no insulin need after day 4.

Conclusions:

• The ketogenic diet (KD) is a promising non-pharmacological intervention for intensive care, particularly for SRSE and glucose stabilization in sepsis.
• Current evidence is limited by small sample sizes, varied protocols, and a lack of randomized trials.
• Further well-designed prospective studies are essential to establish optimal KD protocols and identify specific patient groups who benefit most.