Do you ever start a ketogenic diet in patients who present with status epilepticus admitted to the ICU?

A ketogenic diet can be considered in super-refractory status epilepticus. There are a handful of small studies and case series that are mostly pediatric, but also a few adult papers (Camões et al., PMID 35081248, Katz et al., PMID 33671485, and Cai et al., Acta Epileptologica 2022), which suggest this can be efficacious.

There are issues which make this approach tricky. If the patient is sedated, KD needs to be initiated through tube feeding or parenterally, and working out the nutritional composition of these formulations does require some expertise. Endogenous steroids from acute illness (or administration of steroids) will work against you, and many medications contain carbohydrates in small but intolerable amounts for KD (for example, when reconstituted with dextrose solution).