▸ Thiamine, folate, pantothenic acid, calcium, phosphorus, iron, vitamin D and trace mineral intake likely to be insufficient.13

▸ Omega-3 may be low if dietary fat content primarily from animal sources, eg, butter, cream.13

▸ For bone health. Vitamin D levels often low in children starting ketogenic diets.14 Many anticonvulsants associated with decreased bone mineral density.15

▸ Uric acid stones more common than calcium oxalate stones. Citrates reduce risk of stone formation11 but kidney stones may still occur in 1% of those on citrates.10

▸ Gastrointestinal problems in ≤75% patients, constipation most commonly seen.11

▸ Sudden death, prolonged QT intervals and dilated cardiomyopathy reported with selenium deficiency, but most supplements contain adequate selenium.10

▸ Phosphorus not included in most multivitamin supplements, but might improve bone mineralisation and is an acid buffer.13

▸ Carnitine deficiency rare, but more common in patients taking valproate.10

▸ Anecdotally, energy levels/seizure control improved with carnitine supplementation.13

▸ Carnitine deficiency associated with serious cardiac and hepatic disease; consider when unexplained fatigue or muscle weakness.10

▸ Carnitine needed for long-chain triglyceride breakdown so not necessary for children on MCT diets.10

▸ IKDSG states carnitine supplementation controversial and does not recommend empiric use.5

▸ For constipation (small amounts).5

▸ To add to modular formulas.