Troubleshooting Problems on the Ketogenic Diet

Some children may be sleepier than normal at the start of the diet. If this persists, call your doctor to determine if this is diet or medication related.

Hypoglycemia is a drop in blood sugar to a very low level.

• Symptoms include:
  • Pale skin
  • Sweating
  • Rapid pulse
  • Dizziness
  • Nausea
  • Extreme sleepiness
  • Difficulty speaking
• Treatment: Give 30 ml or 1 oz of juice. Symptoms should improve within 15 – 30 minutes, if not give another 30 ml or 1 oz of juice. Call your doctor.

Excess ketosis means the body is making too many ketones. The ketone strips will change quickly to the highest color for ketones.

• Symptoms include:
  • Nausea
  • Rapid, shallow breathing
  • Facial flushing
  • Vomiting
  • Extreme sleepiness
• Treatment: Give 30 ml or 1 oz of juice, if symptoms persist after 15 minutes give another 30 ml or 1 oz of juice, and then call your primary care doctor. If you are unable to reach your doctor or your child is unable to drink the juice, take your child to the emergency room.

• Check scale for accuracy, remeasure meals
• Call the dietitian to discuss a decrease in calories

• Call the dietitian to discuss:
  • An increase in calories
  • Decrease in the ratio
  • Consider adding a snack

• Be sure of even spacing of meals
• Distracting with toys and physical activity
• Call the dietitian to discuss adjusting the calories or adding a snack

• Call the dietitian to discuss:
  • Review family history
  • Adjusting fats in the diet
  • Omitting bacon, butter
  • Use of mono/polyunsaturated fats
  • MCT oil
  • Changing the ratio
  • Re-evaluation of weight changes and calories

• Monitor frequency of urination and diaper changes (see sick guidelines)
• Use allowed diet beverages to make popsicles and slushes
• Add water to the heavy cream, sweeten with allowed sweeteners and flavor with extracts
• Offer small amounts throughout the day
• Try different sippy cups, allow the child to pick out special cup

Breakthrough seizures are seizures that occur after there is a period of seizure control. The following are some common reasons why breakthrough seizures may occur on the ketogenic diet. The dietitian will assist with changes in the diet if needed.

• May have eaten something not allowed on the diet
• May not have eaten all of the meal
• May have drunk regular soda instead of diet
• Meal incorrectly measured
• Is teething
• Is constipated
• Is ill or becoming ill
• Started a new medication
• Missed anti-seizure medication
• Has gained too much weight
• Has had a recent change in the diet