Maria Raspolic MS RD Santa Clara Valley Medical Center Objectives Review most common nutritional issues in AHC Provide recommendations to minimize above issues Review ketogenic diet as treatment for seizures ID: 636958
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Slide1
Management of Nutritional Issues Associated with Alternating Hemiplegia of Childhood
Maria
Raspolic
MS, RD
Santa Clara Valley Medical CenterSlide2
Objectives:
Review most common nutritional issues in AHC
Provide recommendations to minimize above issuesReview ketogenic diet as treatment for seizures
Management of Nutritional Issues Associated with Alternating Hemiplegia of ChildhoodSlide3
Poor growth
Dehydration
ConstipationDecreased bone mineral densityCommon Nutritional Issues Associated with AHCSlide4
Inadequate nutrient intakes
Decreased muscle tone
Oral motor dysfunction Limited growth potential Frequent illness, fatigue, infections Poor GrowthSlide5
Growth AssessmentSlide6
Provide food of high nutritional quality
Breakfast
: oatmeal, eggs, cream of wheat, yogurt, Carnation Instant Breakfast, meatLunch/Dinner: refried beans/cheese, lentils, tofu, almond/nut butter, avocados, fatty fish, meat, sweet potatoes, fried rice/mex rice
Snacks
: milk shakes/smoothies, cheese stick
InterventionSlide7
Liquid supplements
Concentrate infant formula to 24-30
kca/ozPediasure, Boost Kids Essential, Nutren JrEnsure, Nutren, Boost
Carnation Instant Breakfast
1.5 and 2
cal
/cc formulas
Intervention
con’t
. Slide8
3. Supplemental tube feedingChild not able to gain weight adequately
Excessive time needed to feed
Difficult decision for parentsGoal: improved quality of lifeDramatic improvement in nutritional statusIntervention con’t. Slide9
Inadequate fluid intakesExcessive fluid lossNeed for thickened liquids
Result in constipation, decreased appetite
Kidney stones, UTI, thickening of secretionsMonitor number of diapers, UADehydrationSlide10
100 cc/kg of body wt
for the first 10 kg
50 cc/kg for the second 10 kg20 cc/kg for the additional kgs44 lbs :2.2 = 22 kg1000 + 500 + 40 = 1540 cc
1540: 30 = 51
oz
How much fluid? Slide11
Provide hi nutritional value liquids:Milk, soy, rice, almond, coconut
Smoothies, milkshakes
? juiceRecomendation Slide12
Multifactorial causePoor intakes of fluids and solids
Low muscle tone/ GI motility
Low activity levelsLow fiber dietConstipationSlide13
Contributes to poor appetite
Abdominal distention/discomfort
IrritabilityAdequate fluid intakes and fiberHi fiber foods: cereal (5 gr/serving), legumes Sweet potatoes, fruits/vegetablesPrune or pear juice
Constipation
con’t
. Slide14
If additional help needed:Milk of magnesia
Lactulose
MiralaxBenefiberConstipation
con’t
. Slide15
Limited ambulationInadequate intakes of Ca
,
Phos, Vit DAnticonvulsant therapyLimited sun exposureIf untreated may lead to osteoporosis, bone deformities and fractures
Low Bone mineral DensitySlide16
1-3 years: 500mg
4-8 years 800 mg
9-18 years 1300 mgHow Much Calcium is Needed?Slide17
Food sources/ table
Food Source
Serving Size
Amount of Calcium per Serving
almonds
3 ounces
210 milligrams (mg)
blackstrap molasses
1 tablespoon
170 mg
broccoli (cooked)
1 cup
60 mg
canned salmon (with bones)
3 ounces
180 mg
canned sardines (with bones)
3 ounces
325 mg
collards
1 cup
265 mg
cottage cheese
1 cup
155 mg
hard cheese (cheddar,
swiss
)
1 ounce
225 mg
kale (cooked)
1 cup
95 mg
milk
1 cup300 mgmozzarella cheese1 ounce200 mgrhubarb (cooked)1 cup345 mgricotta cheese1⁄2 cup335 mgspinach (cooked)1 cup245 mgyogurt8 ounces425 mg
Calcium Sources in FoodSlide18
Calcium Carbonate
Viactiv
, Tumbs, CaltrateCalcium Citrate Citracal
Oyster Shell, Bone Meal
Calcium SupplementsSlide19
Sunshine Vitamin
Sunblock use prevents
Vit D productionAnticonvulsant meds (Phenobarb, Dilantin)Decreased absorption of Calcium
Limited food sources: fish liver oil, fatty fish,
egg yolk, mushrooms, milk (fortified)
Vitamin DSlide20
Recommend to check blood levels yearly
Goal: 30-60
mmol/dlSupplement 1000 IU/day 50 000 IU/ weekVit D3 (cholecalciferol) in the skin by sun expoVit
D2 (
ergocalciferol
) synthesized by plants
15 min sun exposure prevent
Vit
D deficiency
Vitamin D
con’t
.Slide21
Borusiak et al, 2012
128 children receiving one AED
24 % hypocalcemia25% hypophosphatemia13% low vit DPhenobarb, Depakote, Trileptal
, Dilantin
Vitamin D
con’t
. Slide22
Common in children with AHCComplete MVI recommended
Chewable tablet preferred
Liquid/soft gummy vits less mineralsBugs Bunny, Flinstone’s, Scooby Doo, NanoVites
Vitamin and Mineral DeficienciesSlide23
How does it work?Brain needs glucose from food
24 hours supply
Breakdown of fat produces ketones??? Prevention of seizuresKetogenic DietSlide24
2-3 months trial30% of the children seizure free30% significant reduction in seizures,
reduction in medication or no medication
Reminder do not respond or find it to hard to continue Chances of success?Slide25
Dehydration-check urine daily with keto
stick
Constipation-MOM, MiralaxKidney Stones- UA, trace amount of bloodNutrient deficiency- complete MVI, ck blood levels ZN, Se, Vit D
Decreased growth- adjust protein, kcal
Hi Cholesterol- replace butter with olive oil,
supplement with
carnitine
Side Effects of the dietSlide26
Gradual decrease in CHO over one week 2-3 day hospital admission
Fasting only in the AM
At lunch time full keto mealAllow fluids to meet hydration needSpec. gravity and ketones check with every void Initiation of the dietSlide27
Teach families how to calculate and prepare
meals
Keto meal planerComplexity of meals controlled by parentsReady to feed Ketogenic formula; KetocalRCF for tube feeding
Initiation of the Diet
con’t
. Slide28
Reduction of the ratio over couple of monthsMost parents find diet easier than anticipated
Ketogenic
diet is the most effective available treatment for intractable epilepsy todayAtkins dietDiscontinuation of the dietSlide29
Any Questions or Comments?