Abstract
In a previous communication 1 data were presented to show the relationship between variations in the degree of ketosis and the occurrence of convulsions in certain epileptic children on ketogenic diets. The convulsions were found to occur practically always during the periods of minimum ketosis as measured by the urinary and blood acetone bodies. However, during the past 12 months, we have repeatedly made the observation recently reported by Lennox, 2 that administration of considerable quantities of sodium bicarbonate to patients under this form of treatment causes temporary recurrence of the convulsions in spite of the diet. This suggested to us the importance of determining the relative efficiency of ketogenic diets having an acid-ash and those containing an excess of base-forming over acid-forming elements.
Observations were made over a total period of 60 days in the case of a 13-year-old patient suffering from severe idiopathic epilepsy. This time was subdivided into periods in which the test diets were given alternately. Except for one period in which a nonketogenic diet with a very highly acid ash was given, the diets throughout were strongly ketogenic, varying only in their ash content. The most notable fact observed from the study was that the convulsive seizures, which practically ceased to occur during the acid-ash, ketogenic diet periods, promptly recurred in alarming numbers when a diet, containing the same amounts of protein, fat and carbohydrate but with a predominantly basic ash, was given. During the relatively long subperiod, when a non-ketogenic diet with a strongly acid ash was given, the patient had from 2 to 12 grand-ma1 attacks daily, in spite of the fact that the diet contained in its ash, according to calculation, an excess of acid equivalent to 11 10 cc. of 0.1 N solution
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