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Case Reports
. 2018 Jun 20:10:61-64.
doi: 10.1016/j.ebcr.2018.05.002. eCollection 2018.

Therapeutic augmentation of ketogenic diet with a sodium-glucose cotransporter 2 inhibitor in a super-refractory status epilepticus patient

Joseph R Blunck  1 , Joseph W Newman  1 , Ronald K Fields  1 , John E Croom  1
Affiliations
Case Reports

Therapeutic augmentation of ketogenic diet with a sodium-glucose cotransporter 2 inhibitor in a super-refractory status epilepticus patient

Joseph R Blunck et al. Epilepsy Behav Case Rep. .

Abstract

Background: A ketogenic diet (KD) may have a role in treating patients in super-refractory status epilepticus (SRSE). Sodium-glucose cotransporter 2 (SGLT2) inhibitors have a risk of ketoacidosis that could facilitate induction of KD.

Case summary: A 42-year-old with a history of drug resistant epilepsy developed SRSE requiring several pharmacological interventions during her hospital course including the initiation of KD that failed. SGLT2 inhibitor therapy was initiated in a successful attempt to augment ketone production.

Conclusion: SGLT2 inhibitors may have a therapeutic value in SRSE patients who cannot achieve ketosis with KD alone.

Keywords: Epilepsy; Ketoacidosis; Ketogenic diet; Ketosis; Pentobarbital; Refractory status epilepticus; Seizure; Sodium-glucose cotransporter 2 inhibitor; Status epilepticus; Super-refractory status epilepticus.

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Figures

Fig. 1
Fig. 1
Serum beta hydroxybutyrate and glucose levels recorded over time (days) during KD. Serum glucose plotted from the left y-axis values with 70 mg/dL (hypoglycemia threshold) represented with black dotted line. Serum beta hydroxybutyrate levels plotted from right y-axis values with 0.6 mmol/L (upper limit of normal) represented with grey dashed line. SGLT2 inhibitor introduced on day 16 post KD represented by the black diamond with ketosis occuring in 7 days. Initiation of lorazepam infusion (propylene glycol source) is represented by a black square on day 33 post KD with subsequent normalization of beta hydroxybutyrate.
Fig. 2
Fig. 2
Representation of SRSE interventions over 121 day course in the neuroscience intensive care unit. Tertiary anesthetic agents were used including pentobarbital titrated for burst suppression starting on day 40. Several pentobarbital weaning attempts are noted with black diamonds with eventual discontinuation on day 105 following consistent ketosis obtainment. Pentobarbital was resumed on day 119 due to relapse of SRSE.
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