PMC6068319_01
Serum beta hydroxybutyrate and glucose levels recorded over time (days) during KD. Serum glucose plotted from the left y-axis values with 70 mg/dL (hypoglycemia threshold) represented with black dotted line. Serum beta hydroxybutyrate levels plotted from right y-axis values with 0.6 mmol/L (upper limit of normal) represented with grey dashed line. SGLT2 inhibitor introduced on day 16 post KD represented by the black diamond with ketosis occuring in 7 days. Initiation of lorazepam infusion (propylene glycol source) is represented by a black square on day 33 post KD with subsequent normalization of beta hydroxybutyrate.
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Approximately 12 weeks after unsuccessful attempts to control the patient's SRSE without infusions of anesthetic agents, the ketogenic diet was initiated with daily monitoring of serum beta hydroxybutyrate (BHB) and serum glucose levels (Fig. 1).
Representation of SRSE interventions over 121 day course in the neuroscience intensive care unit. Tertiary anesthetic agents were used including pentobarbital titrated for burst suppression starting on day 40. Several pentobarbital weaning attempts are noted with black diamonds with eventual discontinuation on day 105 following consistent ketosis obtainment. Pentobarbital was resumed on day 119 due to relapse of SRSE.
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The patient expired after 120 days of SRSE management summarized in Fig. 2.