Table 3.

Management and prevention of most common KDT side effects.

Side effect	Monitoring	Prevention	Management
0–3 months
Hypoglycemia (< 45 mg/dl)	Blood glucose capillary monitoring	Avoid prolonged intervals of daytime fasting and periodically re-evaluate dietary amount of carbohydrates and fat	1/2 glass of fruit juice
Hyperketosis (>6–7 mmol/l)	Ketonemia capillary monitoring	Avoid prolonged intervals of daytime fasting and periodically re-evaluate dietary amount of carbohydrates and fat	1/2 glass of fruit juice
Dehydration	Diuresis	Ensure adequate hydration	Increase liquids or sugar free water gels
3–12 months
Constipation	Bowel habits	Ensure adequate hydration and fiber intake	Mineral oil, glycerin suppository
GE reflux	Specific symptoms	Appropriate anti-reflux behaviors	Prokinetics and acid blockers
Vitamin-mineral deficiency	Blood monitoring	Multivitamin with minerals supplementations	Specific supplementations
Hyperlipidosis	Blood monitoring	Prefer vegetable fats	Replace saturated with unsaturated fats; ω-3 fatty acids of MCT supplementation, reduction of the ketogenic rario
Kidney stones	Diuresis and specific symptoms abdomen ultrasound	Ensure adequate hydration and potassium citrate	Urologic management
>12 months
Abnormal bone metabolism	Vit D and calcium monitoring bone mineralometry	Vitamin D and calcium	Endocrinological management
Growth failure	Auxological and endocrinological monitoring	Adequate caloric intake	Endocrinological management