Oops!…I Did it Again, I Gave You Some Carbs: Prescribing Errors in Inpatient Ketogenic Diet Management

Prescribing Errors in Hospitalized Patients on the Ketogenic Diet Yen CY, Kronisch L, Whitley K, Carew B, Zaldana A, Diaz-Medina G, Katyayan A, Cokley JA. American Journal of Health-System Pharmacy . 2025. Purpose: A ketogenic diet (KD) is recommended as a nonpharmacological treatment option in pediatric patients with epilepsy. Prescribing errors for these patients can result in inadvertent carbohydrate exposure, increasing the risk of loss of ketosis and breakthrough seizures. The objective of this study was to evaluate the incidence of inadvertent carbohydrate exposure in hospitalized children on the traditional KD. Methods: This was a retrospective cohort study of patients with epilepsy receiving KD therapy while admitted to the hospital. Patients 18 years of age or younger diagnosed with epilepsy and/or intractable epilepsy, receiving antiseizure medications on the traditional KD or KD total parenteral nutrition, or with GLUT-1 genetic disorder were included. The primary endpoint was the incidence of patient admissions with unintended orders for carbohydrate-containing medications during hospitalization. Results: A total of 42 patients accounting for 66 inpatient admissions were included in this study. The total incidence of admissions with an inadvertent carbohydrate-containing medication order placed was 52% for intravenous (IV) medications and 64% for oral medications. Patients averaged 2 carbohydrate-containing orders per admission for both IV and oral medications. The most commonly prescribed carbohydrate-containing medications were given at least once before being discontinued. Of the IV medications documented in this study, 6 were premix products diluted in carbohydrate-containing solutions and did not have an alternative file built to facilitate dilution in normal saline. Conclusion: Because of their restricted carbohydrate allowance and the possibility of carbohydrate-containing product excipients, patients on the KD are at increased risk for receiving inappropriate carbohydrate containing medications during hospital admissions.