PKT For Healthcare Providers

Why You Should Pursue PKT

Precision Ketogenic Therapy (PKT) is a dietary therapy to reduce seizures. Carbohydrates are reduced and the calories are replaced with fat. PKT is frequently used when other therapies for epilepsies such as medications have failed. PKT requires a very precise and personalized dietary prescription. It involves a significant amount of work on the part of the caregivers.

  • Keto Diet Differences & Reasons for PKT

    The positive effect of fasting on seizures has been documented for centuries in the writings of many cultures. In 1921, the ketogenic diet was first used medically to treat seizures. In the 1990s, the ketogenic diet for seizures had a resurgence of use in the clinical setting. Another use of a keto diet that has recently become popular is for weight loss and improvement of athletic performance.

     If today there are several versions of the 1921 diet and of the weight loss diets that have been modified to treat seizures, then why was Precision Ketogenic Therapy created?   

     

  • Questions Stemming from Common Misconceptions

    ● Are PKT meals unpalatable, boring, and restrictive?
    ● Can patients be on PKT and get all the nutrients they need?
    ● Will patients lose weight because it is a keto diet or gain weight because of all the fat they eat?
    ● What happens when patients must go off therapy after 2-3 years?
    ● My adult patients would not benefit from the therapy, correct?

How to Introduce PKT To Your Practice

Refer Patients to UF PKT Program

We welcome referrals to our UF PKT program for all your patient’s PKT and neurological care.  The neurologists in either our Pediatric PKT Clinic or in our Adult PKT Clinic can provide all their neurological care and are experienced in integrating PKT into the rest of their care.  The first step is to refer to either UF Pediatric Neurology or UF Adult Epilepsy Division, and the neurologist will refer them to PKT.

Refer Patients for PKT Program Only

We also accept referrals for patients for PKT care only.  You will need to refer to either UF Pediatric Neurology or UF Adult Epilepsy Division, and the neurologists will refer them to PKT and become their PKT neurologist.  All of us will work collaboratively with you to ensure the optimal integration of PKT into the rest of their care.  Continuing communication about the patient among all providers is essential to optimizing PKT. 

Create a PKT Program at Your Facility

You may want to create your own PKT Program at your facility, we are here to assist and collaborate with you to make your implementation of PKT a success. We have created PKT resources or refined the resources of others to ensure the best possible care of patients on PKT. These tools allow us to provide personalized diets for the patients based on the nutrient composition of foods. These resources include: 

●  Nutrition needs calculator
●  Meal equivalent (recipe) calculators
●  Foodomics database
●  Seizure quantitation calculators
●  Antiseizure medication calculators 

Let's walk through the PKT process.

A PKT program is broken down into 4 stages or visits and special visits for special circumstances. Each visit builds on the previous visit. Open communication, making meals, and keeping records between visits are an integral part of the PKT program.

1. Discuss Keto visit

The Discuss Keto Visit is a time for the caregiver to learn and ask questions about the PKT program. The PKT team provides an overview of the program, what is required of the caregiver, and the benefits of the program for the patient. This visit can be in person or telehealth. A blood test is ordered for the patient to determine if PKT initiation is appropriate for the patient. These tests include plasma amino acids, plasma acylcarnitines, and urine organic acid values.

2. Preinitiation  Visit

The Preinitiation Visit is conducted to discuss the details of preparing to start PKT for the patient.  It occurs after it is determined that PKT is appropriate for the patient and PKT is formally offered to the patient.  This visit can be conducted in person or telehealth.

3. Initiation

The PKT initiation transitions the patient from usual dietary intake to PKT. Throughout initiation, the PKT staff adjusts the patient’s ratio of fats, carbohydrates, and proteins until it reaches the recommended amount for their diet prescription. During the initiation, the caregivers learn how to administer PKT. Initiation can be done at home with telehealth or in hospital usually requiring a 3-day, 2-night inpatient stay. 

4. Monitoring Visits

The Monitoring Visits occur on a regular basis, where the PKT staff meets with the patient and caregivers in an inperson or telehealth visit. The PKT staff discusses how the patient has progressed since the last visit and determines if any changes to the diet prescription are neededFor those patients who eat orally, the use of possible new foods in recipes may be discussed. 

Starting PKT Under Special Circumstances

When nothing works for inpatients who are seizing, PKT may be started in the hospital as quickly as possible without the usual planning visits. Preinitiation safety labs are still required. Patients with rare genetic diagnoses may need atypical PKT such as an unusually high keto ratio. Patients with comorbidities requiring treatments accompanied by severe side effects may require frequent tweaking of PKT.

Open Communication Between Visits

Patient families are the ones who administer PKT dailyAs issues arise between scheduled visits, they need answers to their questionsResources needed include phone calls, texts, emails, this website, and zoom callsIn addition to open communication between patients and providers, open communication among all providers of care to the patient is essential because PKT impacts metabolism of all organs All providers should agree on a method of communication that will allow for efficient and secure communication 

Making Meals

Patient acceptance of PKT meals is essential for the patient to stay compliant. Personalized cookbooks are a critical tool for patient success.

The correct PKT diet prescription is the key to having a thriving patient in good nutritional status. The incorrect PKT diet prescription could lead to nutrient deficiencies and accompanying symptoms that require stopping the diet after 2-3 years to recover.

Keeping Records

Accurate and complete records from both the family and the provider are essential to optimal monitoring and optimal treatment of patients.  Although records need to be personalized for each patient, structured templates are helpful when used for documentation of the needed information. 

Keeping Track

Of PKT
  • Screening Labs Before PKT

    Screening labs, fasting plasma amino acids, plasma acylcarnitine profile, and urinary organic acids, are obtained to confirm that a low carbohydrate and high-fat diet will not harm the patient before offering PKT to the patient.

  • Urine Ketones and Specific Gravity

    The state of nutritional ketosis and the level of hydration are important to the success of PKT. Urine ketones are monitored daily to document nutritional ketosis. Although the use of equations to predict fluid requirements is helpful, the use of urine specific gravity is better. Fluid needs fluctuate in many patients, an elevated urine specific gravity is a practical indicator that the patient needs more fluid.

  • Safety Labs for Each Visit

    Since the nutrients used to treat seizures greatly influence the health of many organs; a complete metabolic panel, lipid panel, complete blood count with differential, phosphorus, magnesium, and uric acid are ordered regularly. In addition, beta-hydroxybutyrate concentration in plasma is monitored to document the level of ketosis.

  • Anthropometrics

    Nutrients used to treat seizures must also support a healthy body composition. Regular monitoring of body measurements is used to document a patient’s health. Skinfolds and circumferences are easy to perform, inexpensive, noninvasive, and useful in estimating body composition. In adults, healthy weight and BMI must be maintained, and in children, a healthy growth rate.  

  • Daily Records for Dietary Intake, Dietary Supplements, Medications, And Seizures

    A team effort is required by caregivers and healthcare providers to accurately document the intervention (nutrient intake) and the impact of the intervention (seizures and requirement for antiseizure medication) daily. The data should be used to modify PKT as the patient’s needs change.

Want More?

WE HAVE RESOURCES FOR YOU.

Checklists

Checklists prevent errors, assign responsibility for each task, and document who did what. We have provided some example checklists to help you create your own.

Standard Operating Procedures

Standard Operating Procedures (SOPs) are a crucial step in the quality control of patient care. We have provided our PKT SOPs as samples to help you develop your own.

Templates

Templates are used for data collection, data documentation, and data wrangling. We are happy to share our PKT templates with you.

Education Materials

Education materials are needed by patients, families, healthcare colleagues, and PKT researchers to optimize PKT care. We all need to share what we have so that it can be improved.