Complications of the ketogenic diet

Epilepsia. 1998 Jul;39(7):744-8. doi: 10.1111/j.1528-1157.1998.tb01160.x.


Purpose: The ketogenic diet has been successfully used in treatment of pediatric epilepsy for >70 years. Few serious complications caused by the diet have been reported. We report complications that have been experienced by children receiving the ketogenic diet.

Methods: In a 22-month period, we treated 52 children with the classic ketogenic diet and monitored them in a prospective manner.

Results: Five children (10%) experienced serious adverse events (AE) after initiation of the diet. Four patients (80%) were treated with valproate (VPA) in addition to the diet, as compared with 25 (53%) of the other 47 children. Two patients developed severe hypoproteinemia within 4 weeks of initiation of the diet, and 1 of them also developed lipemia and hemolytic anemia. A third child developed Fanconi's renal tubular acidosis within 1 month of diet initiation. Two other children manifested marked increases in liver function tests, 1 during the initiation phase and the other 13 months later.

Conclusions: Clinicians who wish to use the ketogenic diet must be aware of the potential of serious AE and possible interactions of the diet with VPA.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Carnitine / deficiency
  • Child
  • Child, Preschool
  • Combined Modality Therapy
  • Epilepsy / diet therapy*
  • Epilepsy / drug therapy
  • Follow-Up Studies
  • Food, Formulated / adverse effects*
  • Humans
  • Hypoproteinemia / etiology
  • Infant
  • Ketosis / chemically induced*
  • Liver Diseases / etiology
  • Liver Function Tests / statistics & numerical data
  • Prospective Studies
  • Valproic Acid / therapeutic use


  • Valproic Acid
  • Carnitine