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Table 1 Contraindications to the use of KD-PN

From: Calculation and management of ketogenic diet parenteral nutrition in super-refractory status epilepticus

Absolute contraindications

Disorders of fat metabolism [23]

Carnitine deficiency, carnitine palmitoyl transferase (CPT) I or II deficiency, carnitine translocase deficiency, β-oxidation defects, long /medium/short-chain acyl dehydrogenase deficiency, long/medium-chain 3-hydroxyacyl-CoA deficiency, pyruvate carboxylate deficiency, porphyria

Severe metabolic abnormalities or instabilities

Severe hyperlipidemia (serum TG > 500 mg/dl) [24]

Metabolic acidosis (blood pH < 7.3 [25]; serum CO2 < 12 mmol/l [14])

Sodium < 130 mg/dl, > 150 mg/dL; albumin corrected calcium < 8 mg/dl [26]

Severe hypoglycemia (glucose < 54 mg/dl) [27]

Disease state

Pregnancy [28, 29]

Severe coagulopathy

Severe liver failure; aspartate aminotransferase (AST), alanine aminotransferase (ALT), ammonia > 5*upper limit of normal; total bilirubin > 15 mg/dl, direct bilirubin> 5 mg/dl within 24 h) [26]

Severe kidney failure [29]

Pancreatitis

Irreversibly decerebrate patients [30]

Critical cardiovascular instability [30]

Infants with less than 8 cm of the small bowel [30]

Drugs

Propofol concurrent use or on propofol within 24 h

Relative contraindications

Disease state

Cardiovascular disease (hyperlipidemia, arrhythmia, cardiomyopathy); renal calculi; osteopenia; sepsis; decompensated diabetes mellitus

Metabolic abnormalities

Severe hyponatremia; hypoproteinemia; hyponatremia, hypernatremia, hypocalcemia, hyperketonemia [31]