Yonsei Med J.  2017 Jul;58(4):891-893. 10.3349/ymj.2017.58.4.891.

Protein-Losing Enteropathy as a Complication of the Ketogenic Diet

• Ahn WK
• Park S
• Kim HD

• KMID: 2419101
• DOI: http://doi.org/10.3349/ymj.2017.58.4.891

Abstract

The ketogenic diet is an effective treatment for the patients with intractable epilepsy, however, the diet therapy can sometimes be discontinued by complications. Protein-losing enteropathy is a rarely reported serious complication of the ketogenic diet. We present a 16-month-old Down syndrome baby with protein-losing enteropathy during the ketogenic diet as a treatment for West syndrome. He suffered from diarrhea, general edema and hypoalbuminemia which were not controlled by conservative care for over 1 month. Esophagogastroduodenoscopy and stool alpha-1 antitrypsin indicated protein-losing enteropathy. Related symptoms were relieved after cessation of the ketogenic diet. Unexplained hypoalbuminemia combined with edema and diarrhea during ketogenic suggests the possibility of protein-losing enteropathy, and proper evaluation is recommended in order to expeditiously detect it and to act accordingly.

Keyword

Ketogenic diet; protein-losing enteropathies; hypoalbuminemia

MeSH Terms

Diet, Ketogenic/*adverse effects
Duodenum/pathology
Humans
Infant
Male
Mucous Membrane/pathology
Nutritional Support
Protein-Losing Enteropathies/*complications

Figure

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  Fig. 1 Edematous mucosa and some whitish patches were noted on the duodenum. Slightly edematous gastric mucosa was also noted. Biopsies were acquired from the duodenum and the stomach. Pathology result: ectatic lymphatics in lamina propria, suspicious for intestinal lymphangiectasia.

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  Fig. 2 Scheme of ketogenic diet, nutritional support, evaluation and laboratory data. On HOD2, the ketogenic diet (3:1, fat:non-fat) was started. diarrhea and hypoalbuminemia occurred. through laboratory test, we checked normal renal function, liver function, normal flora in stool culture and noroviral infection confirmed in viral study on HOD16. And parental nutrition and albumin replacement were started. abdominal ultrasonography and thyroid function test were normal on HOD19. On HOD28, the ketogenic diet was reduced from 3:1 to 1.7:1. The symptoms were persistent, and after EGD and echocardiography on HOD61, the ketogenic diet was stopped, and a MCT was started. HOD, hospitalization day; US, abdominal ultrasonography; TFT, thyroid function test; MCT, medium chain triglycerides; A1AT, alpha-1 antitrympsin; EGD, endoscopic gastroduodenoscopy; echo, echocardiography; MCT, medium chain triglyceride diet.

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