Stepwise administration of de novo ketogenic parenteral nutrition for refractory epilepsy during prolonged bowel rest following duodenal perforation

Ketogenic diet is an established therapy for pediatric patients with intractable epilepsy. By shifting energy metabolism from glucose to fat, the diet increases the production of ketone bodies, which alters neuronal excitability and modulates neurotransmitter signaling, thereby raising the seizure threshold. In critically ill children who are unable to tolerate enteral feeds, ketogenic parenteral nutrition (kPN) offers a valuable alternative to the standard ketogenic diet. However, its use has been underutilized and challenged by a lack of standardized protocols. In this report, we present a stepwise approach for initiating kPN in a ketogenic diet‐naive toddler with refractory epilepsy and bowel dysfunction.