The objective of this study was to determine the relationship between
beta-hydroxybutyrate levels and seizure control in children on the
ketogenic diet. Seventy-four children on the
ketogenic diet presenting for routine follow-up visits had blood levels of
beta-hydroxybutyrate correlated with their seizure control. Forty-two children admitted for initiation of the
ketogenic diet had urine
ketones measured by dipstick and correlated with simultaneous blood levels of
beta-hydroxybutyrate. Blood
beta-hydroxybutyrate levels statistically correlated with seizure control (P = .003). Children with blood
beta-hydroxybutyrate levels greater than 4 mmol/L were significantly more likely to have a decrease in seizure frequency than those with levels less than 4 mmol/L. Urine
ketones of 4+ (160 mmol/L) were found on dipstick when blood
beta-hydroxybutyrate levels exceeded 2 mmol/L. Seizure control correlates with blood
beta-hydroxybutyrate levels and is more likely when blood
beta-hydroxybutyrate levels are greater than 4 mmo/L. The traditional measurement of urine
ketones by dipsticks in children on the
ketogenic diet provides a less than optimal assessment of the degree of blood
ketosis. Three to four plus (80-160 mmol/L) urine
ketones are necessary, but not necessarily sufficient, to achieve optimal seizure control in children on the
ketogenic diet. At present, however, urine
ketones are the only readily available inexpensive approach to
ketone assessment.