Ketogenic diet therapy is a high-fat, low-carbohydrate, moderate-protein regimen that results in a sustained metabolic state of ketosis. The diet was originally designed in the 1920s for treatment of epilepsy, but its use has expanded in recent years to other disorders. Most individuals who undergo this therapy are able to consume the diet orally, but those with restricted oral intake require alternative methods of nutrition. Many of our patients have feeding tubes in place for receiving part or all of their nutrition. It is possible to administer the diet during an acute condition or illness in patients who have previously received their nutrition orally. This may be accomplished enterally via a feeding tube or intravenously as parenteral nutrition. This article addresses enteral and parenteral applications of ketogenic diet therapy and provides examples of the modifications that have been successfully implemented at 4 medical centers.
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