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Ketogenic Diet in the Treatment of Pyuria in Childhood

1933; BMJ; Volume: 8; Issue: 43 Linguagem: Inglês

10.1136/adc.8.43.47

1468-2044

J. B. Rennie,

Muscle metabolism and nutrition

In October, 1931, Helmholtz' published results of the treatment of pyuria in children by means of the ketogenic diet.This form of treatment was suggested to him by the observation that the urine of a patient being treated for epilepsy by ketogenic diet remained free of bacterial cloudiness after being kept for a week.He quotes Neilson2, who in 1920 gave cream to patients with urinary infection and claimed good results due to increased acidity of the urine.In spite of previous in vitro experiments showing that the colon bacillus can grow in a medium of an acidity of pH 5 0 Nielson stated that in the absence of obstruction mere inhibition of growth is sufficient to cure a urinary infection.Even before this Shohl and Janney' in 1917 reported that the growth of bacillus coli was inhibited in urine of a pH of 446.At the same time and from the same clinic, Clark' reported a series of adult cases of urinary infection treated by ketogenic diet with good results.Helmholtz postulates two conditions which must be fulfilled for the effective employment of this mode of treatment.First, there must be a state of ketosis induced; and secondly, the urinary pH must be below 5 6.In a test series of four normal cases ammonium chloride was given, resulting in a urinary pH varying from 4 8 to 5 3.The growth of micro-organisms after inoculation and incubation of the urine of these patients was abundant.Again, in a test series of normal cases on ketogenic diet only those urines with pH 5 6 or below were rendered sterile after inoculation with micro- organisms and incubation.Ketosis was present.More recently Wilson5 was completely successful in treating himself with ketogenic diet for a urinary infection which had lasted seven months. Present investigationsThe object of this communcation is to report the results of this form of treatment in a series of six cases.Each patient was investigated on admission with regard to renal function by the ability to excrete phenolsulphonephthalein and to concentrate urea.The non-protein nitrogei of the blood was estimated and intravenous pyelography performed.The patients were then started on the ketogenic diet which was constructed by use of the formula Ketogenic units (K)Fat + 1 Protein Anti-ketogenic units (A.K.)Carbohydrate + I Protein 2