KD patients and routine procedures

If a patient on the Ketogenic Diet requires a routine surgical or medical procedure, it is important to be aware of the following:

Fasting and BSLs

  • Fasting poses a significant risk for Ketogenic Diet patients
  • Try to avoid unnecessary fasting prior to procedures
  • Regular routine monitoring of BSLs required
  • If BSL’s drop while fasting, consider using IV normal saline + 2.5% dextrose to achieve normal sugar levels (see: Management of Hypoglycaemia on the Ketogenic Diet flowchart for more detailed information)

Operative lists

  • Ketogenic Diet patients should be treated as you would treat a diabetic patient i.e. they should be placed FIRST or early on the operative list
  • The anaesthetist should be informed regarding regular monitoring of BSL’s intra-operatively – It is recommended that BSL's are performed every 30-60 minutes.

IV Fluids:

  • Normal saline is the preferred fluid (except where hypoglycaemia present, see above)

Following the procedure/cessation of fasting period:

  • Reinstitute the Ketogenic Diet once fasting/procedure is over
  • Consider using the Ketocal formula NG at 4:1 or 3:1 if the patient cannot yet resume their usual ketogenic diet (e.g. Ortho. and ENT procedures).


It is essential that any newly prescribed medications are sugar-free (or contain minimal carbohydrate content). This applies to all medications including pain relief and antibiotics (e.g. syrups may need to be changed to sugar-free liquid or use crushable tablets).