Sick Day Management on a Ketogenic Diet

School is out, flowers are blooming, fireworks are in the air and it couldn’t be a worse time to get sick.  Let’s face it, we’ve all had those horrible summer sick days. Throw being on a ketogenic diet into the mix, and the result is far from a “summer break”.

KetoVie’s ketogenic dietitian specialists, Rebecca Jennings and Mary Susan Spears, share their tips to help make your sick day more manageable. Rebecca and Mary Susan joined the KetoVie team in order to provide additional resources to our customers. Both are practiced ketogenic dietitians and are always happy to answer any questions you may have about the ketogenic diet! Their biographies and contact information can be found on our website here. While these tips are helpful, they do not replace the necessary communication needed with your keto team to ensure safety.

  • Tip #1. Hydrate.

Encourage fluids to avoid dehydration. Aim for at least 1 cup of fluids every hour, more if a fever is present. Use water or calorie free beverage choices. Diluted Powerade Zero can be used as an electrolyte replacement drink. Refer to the Charlie Foundation’s list of Low Carb and Carb-Free Products for more beverage options ( Signs of dehydration include decreased urine output, dry eyes and dry lips.

  • Tip #2. Maintain diet if possible.

As long as the diet is tolerated, continue the diet as prescribed. If nausea, vomiting or diarrhea are a problem, you can try offering casseroles, soups or ketogenic formula such as KetoVie, so every bite and sip is in the prescribed ratio. You may need to temporarily offer reduced calorie or reduced ratio meals such as broth. Return to the prescribed meal plan as able. Contact your keto team if meals or fluids are not tolerated greater than 24 hours.

  • Tip #3. You may see lower ketones during an illness.

Lower ketosis is common during times of illness. This is due to the body’s natural process to generate more glucose for energy to fight the infection. This response is temporary and you can expect to be back on track once the illness has passed.

  • Tip #4. Double check any new medications with your keto team.

Review any over the counter medications or new prescriptions from your general practitioner with your keto team. Discuss your needs with the pharmacist before paying for a new medication.

  • Tip #5. Avoid becoming too ketotic.

If meals are not tolerated over an extended period of time, it is possible to become overly ketotic. Signs of excess ketosis include rapid breathing, fussiness, nausea, unusual tiredness and facial flushing. Follow your keto center’s guidelines on treating excess ketosis. This often involves giving 30 mL of juice. If symptoms continue after 15 minutes, 30mL of juice is repeated until symptoms resolve. Contact your keto team or seek medical help if symptoms do not improve.

  • Tip #6. If you need IV fluids, ask for NO DEXTROSE.

If you need to seek care at the Emergency Department or Urgent Care, make sure to specify that dextrose not be in the IV bag. Dextrose is a type of sugar. Only in cases of extreme hypoglycemia (low blood sugar) should additional dextrose be used. You may want to ask your keto center for an Emergency Letter for treatment care guidelines should you need to seek emergency care outside of your regular institution.


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