Abstract
RATIONALE: The ketogenic diet (KD) is a dietary regimen characterized by high-fat, moderate-protein, and extremely low-carbohydrate intake. While clinically established as an effective therapy for epilepsy and various metabolic and neurological disorders, its application presents unique challenges in surgical patients requiring perioperative maintenance of ketosis. PATIENT CONCERNS: This report details the multidisciplinary management of a 12-year-old girl who was treated with KD for epilepsy for 10 years, who underwent posterior spinal fusion for scoliosis. At the same time, the need for perioperative care for KD-dependent pediatric patients undergoing complex procedures was also highlighted. DIAGNOSES: Imaging features showed scoliosis. The previous medical history indicates 10 years of KD treatment for epilepsy, intellectual disability for 10 years, and autism for 5 years. INTERVENTIONS: The patient underwent spinal orthopedic surgery after real-time metabolic monitoring (blood glucose/ketone body detection) combined with a tailor-made anesthesia regimen. OUTCOMES: The scoliosis surgery was carried out smoothly, no abnormal conditions occurred during the perioperative period. LESSONS: Maintenance of ketosis is critical throughout the perioperative period to prevent complications including hypoglycemia, seizures, surgical failure, or even mortality in severe cases. At the same time, the use of carbohydrate-free lipid infusion and propofofo-based anesthesia during fasting avoided inadvertent carbohydrate exposure, demonstrating adaptability to perioperative period.