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Volume 7, Issue 3 (Suppl)
J Nutr Disorders Ther, an open access journal
ISSN: 2161-0509
Page 92
JOINT EVENT
&
July 27-29, 2017 Rome, Italy
Advances in Natural Medicines Nutraceuticals & Neurocognition
14
th
International Conference on Clinical Nutrition
13
th
International Congress on
Maximizing the efficacy of the ketogenic diet nutrition medical treatment for super-refractory status
epilepticus
Yeou-mei Christiana Liu
University Avenue(Toronto), Canada
S
uper-refractory status epilepticus (SRSE) is defined as status epilepticus (SE) that continues or recurs despite 24 hours of high
dose suppressive therapy. SRSE carries very significant morbidity in the pediatric population. A retrospective chart review was
done to identify children with SRSE in our hospital. Charts were reviewed for demographic and patient factors, details of diet
administration and outcomes were noted. Eleven children (7 boys, 4 girls), aged 0.5-13.4 years (mean±SD = 8.1±3.5) with SRSE
were identified. In all cases, the diet was given via nasogastric tube. Diet ratios and calories were calculated according to patient’s
weight, age, bowel routine and concomitant treatments (steroid treatment and intubation). During the ICU admission, diets were
modified up to 4 times per patient to achieve adequate ketosis by raising ratios or restricting calories. Ratios were adjusted up to
a 5:1 (92% of daily calorie from fat) for patients with steroid therapy or insufficient ketosis. Post ICU discharge, diet ratios were
reduced, once seizure control was achieved. The KD was effective in aborting SRSE in 9 of 11 children. In these 9 children, the diet
was started between 0-34 days (mean±SD = 11.6±6.2 days) after ICU admission. They were discharged from the ICU 3-43 days
(mean±SD = 15.1±14.1) following admission. In 8 of these 9 children, urinary ketones ranged from 8 to >16 mmol/L. The remaining
children had urine ketones ranging from 4-16 mmol L-1. KD failed to control seizures in 2 patients. In these children, KD treatment
was initiated at 36 and 46 days after onset of SE. In both cases, urinary ketones fluctuated between 0.5 to >16 mmol L-1 and both
were receiving excess carbohydrates (CHO) from medications, which likely contributed to unstable ketosis. Data on longer term
KD management was available for six children. In all, diet ratios were gradually decreased as the seizures improved, to KD ratios
of 2.75:1 (86% of daily calorie from fat) to 4.25:1 (89% of daily calorie from fat). Calories were also adjusted to maintain growth.
We have demonstrated success in utilizing the KD to abort SRSE in children. Multiple diet adjustments of calories and ratios were
required to achieve stable ketosis. Difficulty in eliminating excess -CHO from IV fluids, medications and other sources are a barrier
to effective KD administration in the ICU. In this series, children who did not respond to the KD initiated the diet later in the clinical
course of SRSE. Earlier, initiation of the KD and consistent moderate to high levels of ketosis were more common among those
children in whom the SRSE was aborted. Long-term diet and seizure outcomes in this series are currently under review.
Christiana.liu@sickkids.caDietary supplement–drug interactions of patients with chronic disease in community pharmacy
Chuleegone Sornsuvit, Patcharaporn Thampitak
and
Phandhadeva Tripetch
Chiang Mai University, Thailand
T
he present study is a cross-sectional descriptive study, investigating the interactions between nutritional supplements and
medications in patients with chronic illness. Data was collected by interviewing. A sample of 58 patients with chronic illness
who co-used medications for chronic disease and food supplement: 34 females (58.6%) and 24 males (41.4%), 41 out of 58 are over
60 years old (70.7%). Collecting data was done at Chiang Mai University Pharmacy, Faculty of Pharmacy, Chiang Mai University.
The findings indicated that the medications for chronic illness could be divided into following diseases of 6 groups: hypertension,
dyslipidemia, cardiovascular, diabetes, orthopedic and other chronic diseases. Obviously, the most commonly used drugs were
for 55 hypertension patients (43.6%). Of these drugs, amlodipine was the most taken by 23 patients (18.2%). There are totally
34 types of nutritional supplement divided into 2 groups: 12 vitamins and minerals, 22 natural products. Calcium was the most
common vitamin and mineral (10.6%) while fish oil was the most used natural extract (13.27%). It was found that there were 41
pairs of interactions between nutritional supplements and medications for chronic illness, and the potential interaction was at 1
pair (24.1%). Significantly, fish oil was the most potential food supplement causing drug interactions with amlodipine (8 pairs) and
enalapril (4 pairs). In conclusion, this study can help pharmacists in order to evaluate the possibility of dietary supplement – drug
interactions and giving the consumers practical advice for taking medications.
chujang@hotmail.comJ Nutr Disorders Ther 2017, 7:3(Suppl)
DOI: 10.4172/2161-0509-C1-007