| Patient example |
| A 4 year old male (18 kg) on a 3 : 1 classic ketogenic diet for refractory seizures has a |
| maximum daily carbohydrate requirement of 21 g/daya (or 6 g/meal) and requires |
| treatment for acute otitis media. The physician writes a prescription for amoxicillin |
| (400 mg/5 mL) 10 mL orally twice daily for 10 days and recommends acetaminophen |
| (160 mg/5 mL) 8 mL orally every 6 hours as needed for pain or fever. |
| If both medications are given as scheduled doses, the daily carbohydrate content can be |
| calculated as: |
| (i) Amoxicillin: 3.76 g/dose × 2 doses = 7.5 g carbohydrates/day |
| (ii) Acetaminophen: 8 g CHO/dose × 4 doses = 32 g carbohydrates/day |
| This equates to 39.5 g of carbohydrates per day which is more than the patient’s total |
| daily carbohydrate allowance. Essentially, the patient has received more carbohydrates |
| from his medicine than he would have received from his daily dietary intake of |
| carbohydrates. In this case, the patient would have to restart the inpatient ketosis process |
| in order to maintain ketosis again. If the patient could tolerate swallowing amoxicillin |
| tablets (0 g of carbohydrates/day) and acetaminophen junior strength swallowable tablets |
| (3.2 g of carbohydrates/day), the patient would have received a total of 3.2 g of |
| carbohydrates from his medicine. If the pharmacist communicates this carbohydrate |
| amount to the nutritionist and/or physician, then the patient’s dietary carbohydrates can |
| be reduced by 3.2 g in order to maintain the patient’s total daily carbohydrate intake to |
| 21 g. In the later scenario, ketosis could have been maintained. |
