Management of ketogenic diet therapy in patients with ileostomy: A report of 2 cases

This case series explores the feasibility and clinical considerations of implementing the ketogenic diet therapy (KDT) for epilepsy management in patients with ileostomies. Two pediatric patients with medication-resistant epilepsy and ileostomies continued KDT under clinical supervision. The first patient had an ileostomy placed while on KDT. Fluids and electrolytes were increased initially, although sodium (Na) levels remained within a normal range. The second patient had an ileostomy before starting KDT. Hyponatremia and acidosis occurred initially. With routine laboratory monitoring, and electrolyte and bicarbonate supplementation, normal laboratory values were achieved. Overall fluid needs did not change. Both patients maintained adequate hydration and electrolytes. Seizure control was not compromised in either case while having an ostomy. This study supports the feasibility of KDT in patients with ileostomies, while also highlighting the need for individualized monitoring of hydration status and electrolytes, specifically sodium levels.