Some Effects of a Ketogenic Diet

Abstract

The following study is based on the administration of a ketogenic diet to twenty children between the ages of three and eight years, the majority of cases being chosen with the purpose of testing tolerance to a high fat diet in various conditions. The diet employed, the details of which are given below, was found with slight modification for age to be sufficient to produce a marked ketosis in two to three days in most cases; where it was ineffective in four days, the added factor of restricted fluid intake was employed. A positive ferric chloride test in the urine was taken as the criterion of an adequate ketosis, since Rothera's test is too sensitive to be of equal value. Post-anaesthetic vomiting.-The first point investigated was the effect of ketosis on post-ansesthetic vomiting. It is well known that starvation, and hence vomiting, will produce ketosis in the human subject; the point at issue was whether ketosis, however produced, would in the post-anaesthetic state be likely to result in excessive vomiting. A preliminary comparison was made between two groups each of seven children who were subjected to tonsillectomy. It was not possible to keep the experimental condition exactly uniform for each child as regards operation and anaesthetic, but the former consisted of tonsillectomy by dissection in each case, and the anesthetics employed were ethyl chloride for induction followed by ether. The first group was prepared before operation by the administration of large amounts of carbohydrate, given principally in the form of barley sugar. It was usually possible to give a full half pound of barley sugar on the morning of operation, thus ensuring a high glycogen content of the liver at the time of the anaesthetic. The second group was given no food by mouth on the day of operation. The urine of each patient was tested at six, ten, and twelve hours after operation, and the amount of vomiting noted. As would be expected, the second group all showed ketone bodies in considerable amount in the 10 and 12 hour urines, whilst in the first group ketosis was slight or absent. Two of the first group showed glycosuria in the 6 hour specimen. With regard to the vomiting, every child regurgitated a small amount of bloody vomitus when coming out of the anaesthetic. This was regarded as normal. In only one