Nutrition Strategies While Hospitalized on a Keto or Low-carb Diet

Key Strategies

1. Notify Your Care Team on Admission
   • Ask for a consult with the hospital’s registered dietitian (RD) who knows ketogenic therapy.
   • Bring your macro/ketone ratio, sample menus, and any care letters from your outpatient keto team.
   • If available, request a chart alert (e.g., “Ketogenic Diet / No Sugars”). See guidance: Connecticut Children’s KD Pathway (PDF).
2. Bring Your Own Keto-Friendly Staples & Tools
   • Pre-portioned nuts/seeds, full-fat cheese, MCT oil, sugar-free nut butter, “fat bombs.”
   • Small kitchen scale; ask the kitchen for extra butter, olive oil, or heavy cream to meet ratios.
3. Customize Standard Tray Items
   • Swap toast/cereal/fruit for extra eggs or bacon.
   • Request plain meat or fish (no breading/sugary sauces) with non-starchy vegetables + butter/oil.
   • Order side salads; ask for olive oil & vinegar or full-fat dressing on the side.
4. Advocate for Safe IV Fluids & Medications
   • Confirm carbohydrate-free IV fluids (e.g., normal saline) unless treating hypoglycemia.
   • Have pharmacy review meds for hidden carbs (dextrose, lactose, propylene glycol). Helpful guidance: Matthew’s Friends – Hospital Guidance, KetoCollege Hospital Guidance (PDF), CHOC Ketogenic Diet Guidelines (PDF).
5. Monitor & Record
   • Continue glucose/ketone checks (e.g., every 4 hours if NPO or unwell); bring your own meter/strips.
   • Have a plan for low glucose or excessive ketones per your clinician’s protocol. See: Matthew’s Friends – Hospital Guidance.

Who to Talk To

• Ketogenic/Metabolic RD – tailors meals and monitors labs/ratios.
• Pharmacist – screens IV fluids and meds for hidden carbohydrates.
• Primary & Charge Nurse – reinforce strict no-added-carb orders and fat targets.
• Attending Physician – writes an order set specifying a ketogenic protocol.
• Patient Advocate – helps escalate access to appropriate diet support if needed.

Sample Keto-Friendly Meal Requests

Breakfast

• Scrambled or fried eggs cooked in butter/olive oil
• Bacon, sausage patties, or sliced ham
• Half avocado with extra olive oil
• Black coffee or tea with heavy cream

Lunch

• Grilled chicken, turkey, or fish (no breading; no sweet sauces)
• Spinach/mixed greens salad with olive oil & vinegar
• Steamed broccoli or green beans tossed in butter
• Cheese plate (cheddar, mozzarella, cream cheese)

Dinner

• Pan-seared steak or pork chop with herb butter
• Roasted asparagus or zucchini with olive oil/Parmesan
• Sautéed mushrooms in garlic butter

Optional add-ons (if allowed): olives, seeds, keto broth, extra butter/oil to meet ratios.

Hospital Foods to Avoid

• Bread, bagels, rolls, English muffins
• Cereal, oatmeal, pancakes, waffles
• Potatoes (mashed, fries), rice, pasta, sweet potatoes
• Fruit juices; fruit cups in syrup
• Desserts (pudding, cake, ice cream)
• Sweetened yogurts, flavored milks, sugary gelatin

Keto Meal Plan Resources from Hospitals & Programs

• Cleveland Clinic – Ketogenic Treatment Sample Plan (PDF)
• Boston Children’s Hospital – Ketogenic Diet Overview
• Connecticut Children’s – Ketogenic & Modified KD Clinical Pathway (PDF)
• CHOC Children’s – Ketogenic Diet Clinical Guidelines (PDF)
• Matthew’s Friends – Hospital Guidance for Ketogenic Therapy
• KetoCollege – Hospital Guidance (PDF)
• Diet Doctor – Ordering Low-Carb Food in the Hospital

Additional Patient Tips

• Emergency “Keto-Shake” Kit: Bring ingredients (e.g., MCT oil, heavy cream, unsweetened protein) to bridge gaps.
• Label Brought-In Foods: “High-Fat, Zero-Carb” to help staff handle safely.
• Procedures & Fasting: Confirm carb-free fasting orders; discuss fluids and acid–base monitoring for longer fasts (see PDFs above).
• Micronutrients & Hydration: Ask about supplements (e.g., potassium citrate) and hydration plans to reduce stone risk and side effects.

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Disclaimer: All diets should be supervised by your healthcare team. Always follow individualized medical and dietetic advice.