The ketogenic diet (KD) is a well-accepted treatment modality for children with intractable epilepsy and for inborn errors of carbohydrate metabolism. These children, just as any other child, may be faced with short-term or long-term medical conditions that require parenteral nutrition (PN). Many institutions with KD programs have begun to institute ketogenic PN support for established KD patients who require the diet for seizure control but are acutely unable to be fed for a variety of reasons. However, there are few patients currently being treated with long-term PN providing the necessary high fat percentage to result in therapeutic levels of ketosis. In fact, there are no reported cases of the use of long-term PN to maintain a child in ketosis for seizure control, and only 1 case study documents successful use of short-term use of ketogenic PN. The case report presented is this article describes the initiation, monitoring, and long-term management of ketogenic PN resulting in ketosis in an adolescent requiring long-term PN due to inability to tolerate enteral feeds.
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