The carbohydrate content of medications prescribed to children treated with a ketogenic diet

AbstractBackgroundCarbohydrate excipients include starches, dextrin, maltodextrin, sugar and sugar alcohols. No studies have investigated the cumulative daily carbohydrate content of medications prescribed to children with epilepsy receiving a ketogenic diet.AimsTo calculate carbohydrate contents in medications and the ketogenic ratio of children with intractable epilepsy.MethodsThis retrospective study reviewed the ketogenic diet order forms of children with intractable epilepsy aged <18 years who were admitted to King Chulalongkorn Memorial Hospital, a tertiary referral teaching hospital in Thailand, from 2009 to 2017. All medications were obtained from cross‐sectional medical records. The carbohydrate contents in medications were compiled by a hospital’s database or requested from manufacturers. Overall carbohydrate contents in prescribed medications were calculated and included in grams of carbohydrate in ketogenic ratio.ResultsA total of 169 ketogenic diet order forms of 38 epileptic patients were examined. One hundred and forty‐five oral medications were prescribed, of which oral liquid medications had significantly higher carbohydrate content than solid oral dose forms (p < 0.001). Patients received a median of nine medications of which a median of four were anti‐epileptic medications. The median carbohydrate content in medications was 0.99 g/day (IQR: 0.63–1.77 g/day). The significant difference of ketogenic fat:non‐fat gram ratios was found when prescribed carbohydrate content in medications was higher than 2 g/day.ConclusionsLiquid medications had approximately eight times higher carbohydrate content than solid dosage forms. Comprehensive reviews of the carbohydrate content of medications and the possible association with seizure control should be performed to investigate the clinical significance of this finding.