Table 3.

Intravenous ketogenic diet protocol^a (example for a 30-kg patient).

	Solution	Total volume	Infusion rate	Weight	Calories
bDay 1–2 KD: 400 kcal/d (1/3 of the estimated 70% diet energy needs)
Fat	20% SMOF lipid emulsion	200 ml	12.5 ml/h	40 g fat	360 kcal
Amino acids	4% Aminosteril Infant	250 ml	15.6 ml/h	10 g amino acids	40 kcal
Carbohydrates	0% Dextrose water			0 g carbohydrates	0 kcal
	Total	450 ml		50 g	400 kcal
cDay 3–4 KD: 800 kcal/d (2/3 of the estimated 70% diet energy needs)
Fat	20% SMOF lipid emulsion	400 ml	25 ml/h	80 g fat	720 kcal
Amino acids	4% Aminosteril Infant	250 ml	15.6 ml/h	10 g amino acids	40 kcal
Carbohydrates	5% Dextrose water			10 g carbohydrates	40 kcal
	Total	650 ml		100 g	800 kcal
dAfter day 5 KD: 1200 kcal/d (3/3 of the estimated 70% diet energy needs)
Fat	20% SMOF lipid emulsion	600 ml	37.5 ml/h	120 g fat	1080 kcal
Amino acids	4% Aminosteril Infant	375 ml	23.4 ml/h	15 g amino acids	60 kcal
Carbohydrates	5% Dextrose water			15 g carbohydrates	60 kcal
	Total	975 ml		150 g	1200 kcal

This table is modified from Refs. [9,14,15].

The intravenous ketogenic diet included 20% SMOF (250 ml/bottle) and 4% Aminosteril Infant plus 5% dextrose water (500 ml/bag) and was infused continuously over 16 h and then interrupted for 8 h during the night with glucose-free solution such as half saline.

Abbreviations: KD: ketogenic diet; SMOF: soybean oil, medium-chain triglycerides, olive oil, and fish oil.

^aExample: 70% energy needs is 1200 kcal/day for a 30-kg patient with a classic 4:1 parenteral ketogenic diet.

^bDay 1–2: sugar-free solution.

^cFrom day 3, if sugar >150 or ketone bodies disappear, change 5% dextrose water to sugar-free solution.

^dAfter day 5: Transition to an enteral ketogenic diet if tolerable.