Dietary therapies for childhood epilepsy
Yıl 2013,
Cilt: 48 Sayı: 4, 275 - 280, 01.12.2013
Burak Tatlı
Ayşe Nurcan Cebeci
Barış Ekici
Öz
Ketogenic diet composed of high fat and low carbonhydrate was introduced as a therapeutic alternative for epilepsy in early 20 rsquo;s As new antiepileptic agents such as phenytoin were discovered popularity of the diet was waned until 90 rsquo;s Studies on efficacy of diet in refractory epilepsy reported that approximately half of the children had a significant reduction 15 of whom were seizure free With growing body of evidence and introduction of diet modifications ketogenic diet was promoted as a first line treatment for epileptic encephalopathies such as myoclonic astatic epilepsy Dravet syndrome and infantile spasm Turk Arch Ped 2013; 48: 275 80
Kaynakça
- Guelpa G, Marie A. La lutte contre l’epilepsie par la desintoxication et par la re-education alimentaire. Revue de Therapie MedicoChirurgide 1911; 78: 8-13.
- Geyelin HR. Fasting as a method for treating epilepsy. Medical Record 1921; 99: 1037-9.
- Wilder RM. The effects of ketonemia on course of epilepsy. Mayo Clin Bulletin 1921; 2: 307-8.
- Abrahams J. An introduction to the ketogenic diet: A treatment for pediatric epilepsy (videotape). The Charlie Foundation, Santa Monica, California 1994.
- Kossoff EH, Zupec-Kania BA, Amark PE, et al. Optimal clinical management of children receiving the ketogenic diet: recommendations of the International Ketogenic Diet Study Group. Epilepsia 2009; 50: 304-17. Tatlı ve ark.
- Epilepside ketojenik diyet / Ketogenic diet in epilepsy Levy RG, Cooper PN, Giri P. Ketogenic diet and other dietary treatments for epilepsy. Cochrane Database Syst Rev 2012; 3: CD001903.
- Seo JH, Lee YM, Lee JS, Kang HC, Kim HD. Efficacy and tolerability of the ketogenic diet according to lipid:nonlipid ratios-comparison of 3:1 with 4:1 diet. Epilepsia 2007; 48: 801-5.
- Kossoff EH, Wang HS. Dietary therapies for epilepsy. Biomed J 2013; 36: 2-8.
- Wirrell EC. Ketogenic ratio, calories, and fluids: do they matter? Epilepsia 2008; 49(Suppl 8): 17-9.
- Turner Z, Kossoff EH. The ketogenic and Atkins diet: Recipes for seizure control. Practical Gastroenterology 2006; 30: 53.
- Kossoff EH, Pyzik PL, Furth SL, Hladky HD, Freeman JM, Vining EP. Kidney stones, carbonic anhydrase inhibitors, and the ketogenic diet. Epilepsia 2002; 43: 1168-71.
- Bergqvist AG, Schall JI, Gallagher PR, Cnaan A, Stallings VA. Fasting versus gradual initiation of the ketogenic diet: a prospective, randomized clinical trial of efficacy. Epilepsia 2005; 46: 1810-9.
- Kossoff EH, Krauss GL, McGrogan JR, Freeman JM. Efficacy of the Atkins diet as therapy for intractable epilepsy. Neurology 2003; 61: 1789-91.
- Pfeifer HH, Thiele EA. Low-glycemic-index treatment: a liberalized ketogenic diet for treatment of intractable epilepsy. Neurology 2005; 65: 1810-2.
- Huttenlocher PR, Wilbourn AJ, Signore JM. Medium-chain triglycerides as a therapy for intractable childhood epilepsy. Neurology 1971; 21: 1097-103.
- Dhamija R, Eckert S, Wirrell E. Ketogenic diet. Can J Neurol Sci 2013; 40: 158-67.
- Muzykewicz DA, Lyczkowski DA, Memon N, Conant KD, Pfeifer HH, Thiele EA. Efficacy, safety, and tolerability of the low glycemic index treatment in pediatric epilepsy. Epilepsia 2009; 50: 1118-26.
- Kossoff EH, Dorward JL, Turner Z, Pyzik PL. Prospective study of the modified atkins diet in combination with a ketogenic liquid supplement during the initial month. J Child Neurol 2011; 26: 147
- Klepper J, Leiendecker B. GLUT1 deficiency syndrome--2007 update. Dev Med Child Neurol 2007; 49: 707-16.
- Wexler ID, Hemalatha SG, McConnell J, et al. Outcome of pyruvate dehydrogenase deficiency treated with ketogenic diets. Studies in patients with identical mutations. Neurology 1997; 49: 1655-61.
- Hong AM, Turner Z, Hamdy RF, Kossoff EH. Infantile spasms treated with the ketogenic diet: prospective single-center experience in 104 consecutive infants. Epilepsia 2010; 51: 1403Kilaru S, Bergqvist AG. Current treatment of myoclonic astatic epilepsy: clinical experience at the Children’s Hospital of Philadelphia. Epilepsia 2007; 48: 1703-7.
- Nabbout R, Copioli C, Chipaux M, et al. Ketogenic Ketogenic diet also benefits Dravet syndrome patients receiving stiripentol: a prospective pilot study. Epilepsia 2011; 52: 54-7.
- Kossoff EH, Thiele EA, Pfeifer HH, McGrogan JR, Freeman JM. Tuberous sclerosis complex and the ketogenic diet. Epilepsia 2005; 46: 1684-6.
- Coppola G, Klepper J, Ammendola E, et al. The effects of the ketogenic diet in refractory partial seizures with reference to tuberous sclerosis. Eur J Paediatr Neurol. 2006; 10: 148-51.
- Nangia S, Caraballo RH, Kang HC, Nordli DR, Scheffer IE. Is the ketogenic diet effective in specific epilepsy syndromes? Epilepsy Res 2012; 100: 252-7.
- Nabbout R, Mazzuca M, Hubert P, et al. Efficacy of ketogenic diet in severe refractory status epilepticus initiating fever induced refractory epileptic encephalopathy in school age children (FIRES). Epilepsia 2010; 51: 2033-7.
- Villeneuve N, Pinton F, Bahi-Buisson N, Dulac O, Chiron C, Nabbout R. The ketogenic diet improves recently worsened focal epilepsy. Dev Med Child Neurol 2009;51: 276-81.
- Rho JM, Stafstrom CE. The ketogenic diet: what has science taught us? Epilepsy Res 2012; 100: 210-7.
- Keith HM. Factors influencing experimentally produced convulsions. Arch Neurol Psychiatr 1933; 29: 148-54.
- Rho JM, Anderson GD, Donevan SD, White HS. Acetoacetate, acetone, and dibenzylamine (a contaminant in l-(+)-betahydroxybutyrate) exhibit direct anticonvulsant actions in vivo. Epilepsia 2002; 43: 358-61.
- Dutton SB, Sawyer NT, Kalume F, et al. Protective effect of the ketogenic diet in Scn1a mutant mice . Epilepsia 2011; 52: 2050-6.
- Bough KJ, Yao SG, Eagles DA. Higher ketogenic diet ratios confer protection from seizures without neurotoxicity. Epilepsy Res 2000; 38: 15-25.
- Appleton DB, DeVivo DC. An animal model for the ketogenic diet. Epilepsia 1974; 15: 211-27.
- Hartman AL, Lyle M, Rogawski MA, Gasior M. Efficacy of the ketogenic diet in the 6-Hz seizure test. Epilepsia 2008; 49: 334-9.
- Thavendiranathan P, Mendonca A, Dell C, et al. T The MCT ketogenic diet: effects on animal seizure models. Exp Neurol 2000; 161: 696-703.
- Daikhin Y, Yudkoff . Ketone bodies and brain glutamate and GABA metabolism. Dev Neurosci 1998; 20: 358-64.
- Kumada T, Nishii R, Higashi T, et al. Ketogenic diet may control seizures by increasing the binding potential of the benzodiazepine receptor: a speculation from the [11C] flumazenil-PET study. No To Hattatsu 2012; 44: 50-4.
- Fraser DD, Whiting S, Andrew RD, Macdonald EA, Musa-Veloso K, Cunnane SC. Elevated polyunsaturated fatty acids in blood serum obtained from children on the ketogenic diet. Neurology 2003; 60: 1026-9.
- Bromfield E, Dworetzky B, Hurwitz S, et al. A randomized trial of polyunsaturated fatty acids for refractory epilepsy. Epilepsy Behav 2008; 12: 187-90.
- Noh HS, Kim YS, Lee HP, et al. The protective effect of a ketogenic diet on kainic acid-induced hippocampal cell death in the male ICR mice. Epilepsy Res 2003; 53: 119-28.
- Veech RL. The therapeutic implications of ketone bodies: the effects of ketone bodies in pathological conditions: ketosis, ketogenic diet, redox states, insulin resistance, and mitochondrial metabolism. Prostaglandins Leukot Essent Fatty Acids 2004; 70: 309Ziegler DR, Ribeiro LC, Hagenn M, et al. Ketogenic diet increases glutathione peroxidase activity in rat hippocampus. Neurochem Res 2003; 28: 1793-7.
- DeVivo DC, Leckie MP, Ferrendelli JS, McDougal DB Jr. Chronic ketosis and cerebral metabolism. Ann Neurol 1978; 3: 331-7.
- Huang YZ, McNamara JO. Inhibiting glycolysis to reduce seizures: how it might work. Nat Neurosci 2006; 9: 1351-2.
- Stafstrom CE, Ockuly JC, Murphree L, Valley MT, Roopra A, Sutula TP. Anticonvulsant and antiepileptic actions of 2-deoxy-Dglucose in epilepsy models. Ann Neurol 2009; 65: 435-47.
- He XP, Kotloski R, Nef S, Luikart BW, Parada LF, McNamara JO. Conditional deletion of TrkB but not BDNF prevents epileptogenesis in the kindling model. Neuron 2004; 43: 31-42.
- Xu L, Rensing N, Yang XF, et al. Leptin inhibits 4-aminopyridineand pentylenetetrazole-induced seizures and AMPAR-mediated synaptic transmission in rodents. J Clin Invest 2008; 118: 272-80.
- Kang HC, Chung DE, Kim DW, Kim HD. Early- and late-onset complications of the ketogenic diet for intractable epilepsy. Epilepsia 2004; 45: 1116-23.
- Furth SL, Casey JC, Pyzik PL, et al. Risk factors for urolithiasis in children on the ketogenic diet. Pediatr Nephrol 2000; 15: 125-8.
- Kwiterovich PO Jr, Vining EP, Pyzik P, Skolasky R Jr, Freeman JM. Effect of a high-fat ketogenic diet on plasma levels of lipids, lipoproteins, and apolipoproteins in children. JAMA 2003; 290: 912Vining EP, Pyzik P, McGrogan J, et al. Growth of children on the ketogenic diet . Dev Med Child Neurol 2002; 44: 796-802.
- Nangia S, Caraballo RH, Kang HC, Nordli DR, Scheffer IE. I Is the ketogenic diet effective in specific epilepsy syndromes? Epilepsy Res 2012;100: 252-7.
- Berry-Kravis E, Booth G, Sanchez AC, Woodbury-Kolb J. Carnitine levels and the ketogenic diet. Epilepsia 2001; 42: 1445-51.
- Bergqvist AG, Schall JI, Stallings VA, Zemel BS. Progressive bone mineral content loss in children with intractable epilepsy treated with the ketogenic diet. Am J Clin Nutr 2008; 88: 1678-84.
- Sirikonda NS, Patten WD, Phillips JR, Mullett CJ. Ketogenic diet: rapid onset of selenium deficiency-induced cardiac decompensation. Pediatr Cardiol 2012; 33: 834-8.
- Buse GJ, Riley KD, Dress CM, Neumaster TD. Patient with gemfibrozil-controlled hypertriglyceridemia that developed acute pancreatitis after starting ketogenic diet. Curr Surg 2004; 61: 224-6.
- Bergqvist AG, Schall JI, Stallings VA. Vitamin D status in children with intractable epilepsy, and impact of the ketogenic diet. Epilepsia 2007; 48: 66-71.
- McNally MA, Pyzik PL, Rubenstein JE, Hamdy RF, Kossoff EH. Empiric use of oral Empiric use of potassium citrate reduces kidney-stone incidence with the ketogenic diet. Pediatrics 2009; 124: 300-4.
Çocukluk çağı epilepsilerinde diyet tedavisi
Yıl 2013,
Cilt: 48 Sayı: 4, 275 - 280, 01.12.2013
Burak Tatlı
Ayşe Nurcan Cebeci
Barış Ekici
Öz
Besin alerjisi besin proteinlerine karşı geliştirilen spesifik IgE antikorları aracılığı ile ortaya çıkan Tip I aşırı duyarlılık reaksiyonu olarak tanımlanmaktadır Dünyada olduğu gibi ülkemizde de tüm alerjik hastalıklarda olduğu gibi besin alerjisinin görülme sıklığı giderek artmaktadır Anne baba ya da kardeşlerinde alerjik rinit bronşiyal astım atopik dermatit ve besin alerjisi gibi alerjik etiolojiye dayalı bir hastalık bulunan bebekler besin allerjisi açısından yüksek risk grubundadırlar Besin alerjisi yönünden risk grubunda bulunan bebeklere uygulanması gereken tanı ve tedavi yöntemlerinin belirlenmesi doğru tanı ve tedavinin yapılabilmesinde yararlı olacaktır ldquo;Çocuk Alerji ve Astım Akademisi Derneği rdquo; olarak hazırladığımız bu protokolün amacı; ldquo;Aile Hekimleri rdquo; ve ldquo;Çocuk Sağlığı ve Hastalıkları Uzmanları rdquo; için besin alerjilerinin tanınması ve tedavisi konusunda bir kaynak olarak yol gösterici olmaktır Türk Ped Arfl 2013; 48: 270 4
Kaynakça
- Guelpa G, Marie A. La lutte contre l’epilepsie par la desintoxication et par la re-education alimentaire. Revue de Therapie MedicoChirurgide 1911; 78: 8-13.
- Geyelin HR. Fasting as a method for treating epilepsy. Medical Record 1921; 99: 1037-9.
- Wilder RM. The effects of ketonemia on course of epilepsy. Mayo Clin Bulletin 1921; 2: 307-8.
- Abrahams J. An introduction to the ketogenic diet: A treatment for pediatric epilepsy (videotape). The Charlie Foundation, Santa Monica, California 1994.
- Kossoff EH, Zupec-Kania BA, Amark PE, et al. Optimal clinical management of children receiving the ketogenic diet: recommendations of the International Ketogenic Diet Study Group. Epilepsia 2009; 50: 304-17. Tatlı ve ark.
- Epilepside ketojenik diyet / Ketogenic diet in epilepsy Levy RG, Cooper PN, Giri P. Ketogenic diet and other dietary treatments for epilepsy. Cochrane Database Syst Rev 2012; 3: CD001903.
- Seo JH, Lee YM, Lee JS, Kang HC, Kim HD. Efficacy and tolerability of the ketogenic diet according to lipid:nonlipid ratios-comparison of 3:1 with 4:1 diet. Epilepsia 2007; 48: 801-5.
- Kossoff EH, Wang HS. Dietary therapies for epilepsy. Biomed J 2013; 36: 2-8.
- Wirrell EC. Ketogenic ratio, calories, and fluids: do they matter? Epilepsia 2008; 49(Suppl 8): 17-9.
- Turner Z, Kossoff EH. The ketogenic and Atkins diet: Recipes for seizure control. Practical Gastroenterology 2006; 30: 53.
- Kossoff EH, Pyzik PL, Furth SL, Hladky HD, Freeman JM, Vining EP. Kidney stones, carbonic anhydrase inhibitors, and the ketogenic diet. Epilepsia 2002; 43: 1168-71.
- Bergqvist AG, Schall JI, Gallagher PR, Cnaan A, Stallings VA. Fasting versus gradual initiation of the ketogenic diet: a prospective, randomized clinical trial of efficacy. Epilepsia 2005; 46: 1810-9.
- Kossoff EH, Krauss GL, McGrogan JR, Freeman JM. Efficacy of the Atkins diet as therapy for intractable epilepsy. Neurology 2003; 61: 1789-91.
- Pfeifer HH, Thiele EA. Low-glycemic-index treatment: a liberalized ketogenic diet for treatment of intractable epilepsy. Neurology 2005; 65: 1810-2.
- Huttenlocher PR, Wilbourn AJ, Signore JM. Medium-chain triglycerides as a therapy for intractable childhood epilepsy. Neurology 1971; 21: 1097-103.
- Dhamija R, Eckert S, Wirrell E. Ketogenic diet. Can J Neurol Sci 2013; 40: 158-67.
- Muzykewicz DA, Lyczkowski DA, Memon N, Conant KD, Pfeifer HH, Thiele EA. Efficacy, safety, and tolerability of the low glycemic index treatment in pediatric epilepsy. Epilepsia 2009; 50: 1118-26.
- Kossoff EH, Dorward JL, Turner Z, Pyzik PL. Prospective study of the modified atkins diet in combination with a ketogenic liquid supplement during the initial month. J Child Neurol 2011; 26: 147
- Klepper J, Leiendecker B. GLUT1 deficiency syndrome--2007 update. Dev Med Child Neurol 2007; 49: 707-16.
- Wexler ID, Hemalatha SG, McConnell J, et al. Outcome of pyruvate dehydrogenase deficiency treated with ketogenic diets. Studies in patients with identical mutations. Neurology 1997; 49: 1655-61.
- Hong AM, Turner Z, Hamdy RF, Kossoff EH. Infantile spasms treated with the ketogenic diet: prospective single-center experience in 104 consecutive infants. Epilepsia 2010; 51: 1403Kilaru S, Bergqvist AG. Current treatment of myoclonic astatic epilepsy: clinical experience at the Children’s Hospital of Philadelphia. Epilepsia 2007; 48: 1703-7.
- Nabbout R, Copioli C, Chipaux M, et al. Ketogenic Ketogenic diet also benefits Dravet syndrome patients receiving stiripentol: a prospective pilot study. Epilepsia 2011; 52: 54-7.
- Kossoff EH, Thiele EA, Pfeifer HH, McGrogan JR, Freeman JM. Tuberous sclerosis complex and the ketogenic diet. Epilepsia 2005; 46: 1684-6.
- Coppola G, Klepper J, Ammendola E, et al. The effects of the ketogenic diet in refractory partial seizures with reference to tuberous sclerosis. Eur J Paediatr Neurol. 2006; 10: 148-51.
- Nangia S, Caraballo RH, Kang HC, Nordli DR, Scheffer IE. Is the ketogenic diet effective in specific epilepsy syndromes? Epilepsy Res 2012; 100: 252-7.
- Nabbout R, Mazzuca M, Hubert P, et al. Efficacy of ketogenic diet in severe refractory status epilepticus initiating fever induced refractory epileptic encephalopathy in school age children (FIRES). Epilepsia 2010; 51: 2033-7.
- Villeneuve N, Pinton F, Bahi-Buisson N, Dulac O, Chiron C, Nabbout R. The ketogenic diet improves recently worsened focal epilepsy. Dev Med Child Neurol 2009;51: 276-81.
- Rho JM, Stafstrom CE. The ketogenic diet: what has science taught us? Epilepsy Res 2012; 100: 210-7.
- Keith HM. Factors influencing experimentally produced convulsions. Arch Neurol Psychiatr 1933; 29: 148-54.
- Rho JM, Anderson GD, Donevan SD, White HS. Acetoacetate, acetone, and dibenzylamine (a contaminant in l-(+)-betahydroxybutyrate) exhibit direct anticonvulsant actions in vivo. Epilepsia 2002; 43: 358-61.
- Dutton SB, Sawyer NT, Kalume F, et al. Protective effect of the ketogenic diet in Scn1a mutant mice . Epilepsia 2011; 52: 2050-6.
- Bough KJ, Yao SG, Eagles DA. Higher ketogenic diet ratios confer protection from seizures without neurotoxicity. Epilepsy Res 2000; 38: 15-25.
- Appleton DB, DeVivo DC. An animal model for the ketogenic diet. Epilepsia 1974; 15: 211-27.
- Hartman AL, Lyle M, Rogawski MA, Gasior M. Efficacy of the ketogenic diet in the 6-Hz seizure test. Epilepsia 2008; 49: 334-9.
- Thavendiranathan P, Mendonca A, Dell C, et al. T The MCT ketogenic diet: effects on animal seizure models. Exp Neurol 2000; 161: 696-703.
- Daikhin Y, Yudkoff . Ketone bodies and brain glutamate and GABA metabolism. Dev Neurosci 1998; 20: 358-64.
- Kumada T, Nishii R, Higashi T, et al. Ketogenic diet may control seizures by increasing the binding potential of the benzodiazepine receptor: a speculation from the [11C] flumazenil-PET study. No To Hattatsu 2012; 44: 50-4.
- Fraser DD, Whiting S, Andrew RD, Macdonald EA, Musa-Veloso K, Cunnane SC. Elevated polyunsaturated fatty acids in blood serum obtained from children on the ketogenic diet. Neurology 2003; 60: 1026-9.
- Bromfield E, Dworetzky B, Hurwitz S, et al. A randomized trial of polyunsaturated fatty acids for refractory epilepsy. Epilepsy Behav 2008; 12: 187-90.
- Noh HS, Kim YS, Lee HP, et al. The protective effect of a ketogenic diet on kainic acid-induced hippocampal cell death in the male ICR mice. Epilepsy Res 2003; 53: 119-28.
- Veech RL. The therapeutic implications of ketone bodies: the effects of ketone bodies in pathological conditions: ketosis, ketogenic diet, redox states, insulin resistance, and mitochondrial metabolism. Prostaglandins Leukot Essent Fatty Acids 2004; 70: 309Ziegler DR, Ribeiro LC, Hagenn M, et al. Ketogenic diet increases glutathione peroxidase activity in rat hippocampus. Neurochem Res 2003; 28: 1793-7.
- DeVivo DC, Leckie MP, Ferrendelli JS, McDougal DB Jr. Chronic ketosis and cerebral metabolism. Ann Neurol 1978; 3: 331-7.
- Huang YZ, McNamara JO. Inhibiting glycolysis to reduce seizures: how it might work. Nat Neurosci 2006; 9: 1351-2.
- Stafstrom CE, Ockuly JC, Murphree L, Valley MT, Roopra A, Sutula TP. Anticonvulsant and antiepileptic actions of 2-deoxy-Dglucose in epilepsy models. Ann Neurol 2009; 65: 435-47.
- He XP, Kotloski R, Nef S, Luikart BW, Parada LF, McNamara JO. Conditional deletion of TrkB but not BDNF prevents epileptogenesis in the kindling model. Neuron 2004; 43: 31-42.
- Xu L, Rensing N, Yang XF, et al. Leptin inhibits 4-aminopyridineand pentylenetetrazole-induced seizures and AMPAR-mediated synaptic transmission in rodents. J Clin Invest 2008; 118: 272-80.
- Kang HC, Chung DE, Kim DW, Kim HD. Early- and late-onset complications of the ketogenic diet for intractable epilepsy. Epilepsia 2004; 45: 1116-23.
- Furth SL, Casey JC, Pyzik PL, et al. Risk factors for urolithiasis in children on the ketogenic diet. Pediatr Nephrol 2000; 15: 125-8.
- Kwiterovich PO Jr, Vining EP, Pyzik P, Skolasky R Jr, Freeman JM. Effect of a high-fat ketogenic diet on plasma levels of lipids, lipoproteins, and apolipoproteins in children. JAMA 2003; 290: 912Vining EP, Pyzik P, McGrogan J, et al. Growth of children on the ketogenic diet . Dev Med Child Neurol 2002; 44: 796-802.
- Nangia S, Caraballo RH, Kang HC, Nordli DR, Scheffer IE. I Is the ketogenic diet effective in specific epilepsy syndromes? Epilepsy Res 2012;100: 252-7.
- Berry-Kravis E, Booth G, Sanchez AC, Woodbury-Kolb J. Carnitine levels and the ketogenic diet. Epilepsia 2001; 42: 1445-51.
- Bergqvist AG, Schall JI, Stallings VA, Zemel BS. Progressive bone mineral content loss in children with intractable epilepsy treated with the ketogenic diet. Am J Clin Nutr 2008; 88: 1678-84.
- Sirikonda NS, Patten WD, Phillips JR, Mullett CJ. Ketogenic diet: rapid onset of selenium deficiency-induced cardiac decompensation. Pediatr Cardiol 2012; 33: 834-8.
- Buse GJ, Riley KD, Dress CM, Neumaster TD. Patient with gemfibrozil-controlled hypertriglyceridemia that developed acute pancreatitis after starting ketogenic diet. Curr Surg 2004; 61: 224-6.
- Bergqvist AG, Schall JI, Stallings VA. Vitamin D status in children with intractable epilepsy, and impact of the ketogenic diet. Epilepsia 2007; 48: 66-71.
- McNally MA, Pyzik PL, Rubenstein JE, Hamdy RF, Kossoff EH. Empiric use of oral Empiric use of potassium citrate reduces kidney-stone incidence with the ketogenic diet. Pediatrics 2009; 124: 300-4.