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Flashcards in Keto for epilepsy Deck (64)
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1
Q

__% of epilepsy uncontrolled w/ meds

A

30

2
Q

surgical candidates are those with ___ that can be removed

A

lesions

3
Q

high fat diet designed to mimic metabolic effects of starvation, used to treat epilepsy

A

keto diet

4
Q

ketone bodies produced by ____

A

liver mitochondria

5
Q

short and medium chain f.a. are oxidized only in ____, long and very long chain oxidized in ___ as well

A

mitochondria; peroxisomes

6
Q

how are ketone bodies made?

A

shunt excess acetyl coA to ketogenesis

7
Q

why infant brain more efficient extract/utilize ketone bodies from blood?

A

higher lvls ketone metabolizing enzymes and monocarboxylic acid transporters

8
Q

___ can produce ketone bodies under conditions of glucose utilization

A

astrocytes

9
Q

brain ^ lvls of monocarboxylic acid transporters and ketone metabolizing enzymes rapidly during periods of _____

A

stress (trauma, ischemia, low glucose)

10
Q

direct mechanism of ketogenic diet fxn:

A

alternative fuel provision

11
Q

indirect mech of keto diet fxn:

A

mito biogenesis, neurotransmitter metabolism, antioxidant status, epigenetic mechanism

12
Q

free fatty acids metabolize into ___ and ___

A

acetoacetate; betahydroxybutyrate

13
Q

GABA is an _____ neurotransmitter and is synth by ____ cycle intermediate alpha ketoglutarate via glutamate and glutamate decarboxylase

A

inhibitory; Kreb’s

14
Q

___ is a known inhibitor of glutamate decarboxylase

A

aspartate

15
Q

possible mechanisms of keto diet on GABA?

A

affect GABA lvls, shunt flow, or responsiveness within brain

16
Q

K ATP channels activated when cell ATP levels are ____, they have a _____ effect

A

low; hyperpolarization

17
Q

Keto increases ____ levels, stabilizing membrane potential

A

ATP

18
Q

how does keto diet work directly?

A

alternative fuel provision

19
Q

how does keto diet work indirectly?

A

mitochondrial biogenesis, neurotransmitter metabolism, antioxidant status, epigenetic mechanism

20
Q

common adverse events:

A

renal stones/haematuria, hypoglycemia

21
Q

keto bloodwork is performed pre-keto and every ___ months

A

6

22
Q

pre-keto screen for ____

A

f.a. oxidation defects

23
Q

ab ultrasound used to check for ____

A

non alcoholic fatty liver

24
Q

all ingredients in meal must be ___

A

weighed or measured

25
Q

variables to consider when initiating keto?

A

family, community resources, keto diet team, hospital resources, keto diet candidate

26
Q

variables pt keto diet candidate?

A

time away from work, selective food preferences, time away from family in hospital, coping skills to change, med acuity

27
Q

family considerations?

A

equipment and food affordability, family dynamics to cope with change, cost of admission

28
Q

community resources to consider?

A

keto diet family support groups, outpatient lab access, internet access, cooking demos, education of local community/work place/school

29
Q

keto diet team considerations:

A

availability of RD, inpatient/outpatient services, professionals available

30
Q

hospital resources to consider:

A

training of staff, cost of admission, availability of team members, outpatient/inpatient

31
Q

recommendations for pre-keto diet evaluation:

A

teaching/counselling, nutr evaluation of current diet, eating pattern, anthro, labs

32
Q

methods of initiation?

A

outpatient/inpatient, slow/fast titration, how to titrate, hydration restriction/no restriction, fasting/non fasting

33
Q

inpatient initation uses ___ titration, appropriate for med unstable pt

A

rapid

34
Q

rapid titration is over ____ and slow is over ___

A

days; weeks

35
Q

advantage of slow titration?

A

less side effects, no hospital admission needed, adjustment to lifestyle gradual, longer window monitor efficacy, RD time not as concentrated (more balance), ease of new lifestyle transition

36
Q

advantages rapid titration?

A

achieve ketosis sooner, seizure control sooner, pt/family very motivated and capable for rapid change

37
Q

disadvantage of gradual?

A

take longer see seizure control

38
Q

disadvantage of rapid?

A

KD prescription more restrictive than necessary, acute side effects, fast adjustment

39
Q

side effects common to fasting:

A

hypoglycemia, acidosis, IVF, wt loss

40
Q

ketogenic ratio is grams of ___ to sum of grams of ______

A

fat; pro and CHO

41
Q

what are typical keto ratios?

A

3:1 and 4:1

42
Q

challenge of keto ratios?

A

difficult compare KD prescription when describing in ratios, since don’t adequately describe g of pro and CHO

43
Q

method 2 of titration?

A

titrate via % calories of macros or grams

44
Q

% calories is more ____ than keto ratios

A

precise

45
Q

what is method 3 of titration?

A

set initial goal of g of CHO/day

46
Q

modified atkins diet has ____ g CHO / day

A

10-20

47
Q

low glycemic index diet has _____ g CHO/day

A

40-60

48
Q

examples of menus/exchange lists?

A

fruit and veg exchange, food exchange, custom menus, glycemic index lists, fat/pro/CHO exchange list

49
Q

inpatient rapid titration uses ____ keto diet, outpatient slow titration uses ______ ratio, ___ initiation

A

classical; low; slow

50
Q

outpatient rapid titration uses ___ diet and ___ diet

A

modified atkins; low glycemic

51
Q

after first month of modified atkins may ^ net CHO by _____ g/day

A

5-10

52
Q

diff between keto and mod atkins?

A

restricted vs unrestricted cals, sometimes fasting vs. no fasting, measure food vs no measuring food

53
Q

home monitoring for low ratio slow initation:

A

daily cap blood sugars, daily urine ketones, weekly blood ketones

54
Q

how to rehydrate in inpatient?

A

non-dextrose IV solutions, 0.5 strength pedialyte (oral or tube feeding)

55
Q

reasons for hypoglycemia?

A

losses from vomiting/diarrhea, inadequate/poor intake

56
Q

measure cap blood sugars q ___ hours until resolved then can reduce to q ____ hours

A

3-4; 4-6

57
Q

goal for hypoglycemia is ___mmol/L or greater

A

3.0

58
Q

reasons for acidosis:

A

prolonged fasting, poorly hydrated, carbonic anhydrase inhibitor meds, keto ratio is too high, keto ratio is acceptable but pt refuses to take in CHO component of meal

59
Q

normal pH bicarb is ___ mmol/L or greater

A

18

60
Q

goal when have ketosis is ___ mmol/L

A

8-16

61
Q

if hyperketosis, consider giving ____% more non carb fluid

A

10-25

62
Q

if < 8 mmol/L in urine may be false low, make sure urine sample was ___

A

fresh

63
Q

__ scores to determine trend of growth

A

z

64
Q

reasons for constipation:

A

very low fibre intake in keto diet, inadequate fluid intake, gut motility is compromised