Ketogenic Diet Sick Day Guidelines

Continue to call your primary care doctor for any illness or injury just as you would have prior to use of the ketogenic diet.

Colds and Flu

In most cases, your child should be able to continue with diet and fluids. Extra fluids should be encouraged with a fever.

Nausea, Vomiting or Diarrhea

Seek medical attention if vomiting or diarrhea continues beyond 24 hours. If there is any doubt call your primary care doctor immediately.

• Give only clear liquids, offer liquids every hour while awake to avoid dehydration. Do not limit the amount taken in 24 hours.
• Offer water, caffeine-free diet beverages, sugar-free gelatin, half-strength Pedialyte, broth, Powerade Zero, Propel Zero.

If fluids are well tolerated and your child is asking to eat, resume ketogenic meals.

• Start with half portions of a meal
• If possible, choose all in one recipes or meals to ensure the correct ratio in every bite
• If fat is poorly tolerated then use one-half of the total fat content of the meal or recipe
• If drinking Ketocal 3:1 or 4:1 dilute to one-half strength
• Advance to full strength meals or Ketocal 3:1 or 4:1 as tolerated

For NG or G-tube feeds

• Start with water or half strength Pedialyte. For bolus feedings give ¼ to ½ the usual volume for one to two feeds. If feeds are given continuously run for four to eight hours.
• If tolerated give the ketogenic formula diluted with water to one-half strength. For bolus feedings give ¼ to ½ the usual volume for one to two feeds. If feeds are given continuously run for four to eight hours.
• If tolerated advance to usual volume of feeds, then advance to full strength.

Constipation

• Include 25gm lettuce, from the free food list, daily; use more Group A vegetables
• Be sure your child is getting all the recommended fluids
• Discuss use of a laxative or stool softener with your primary care doctor
• Carbohydrate free laxatives/stool softeners:
  • Milk of Magnesia
  • Miralax
  • Glycerin suppository
  • Colace capsule, 1% solution, or suppository Fleets enema
• Discuss use of coconut or MCT oil with the dietitian