Importance of Fluid Intake for Patients on the Ketogenic Diet

For children on the ketogenic (keto) diet, keeping hydrated is essential to prevent constipation and kidney stones. The high-fat content of the diet makes it more difficult for the body to break down the nutrients in foods and convert it to energy if it is not accompanied by water, which is quickly processed by the body.

Your child’s keto meal plan includes their ideal fluid intake. To help prevent dehydration, your child can always have more fluid than what’s recommended.

Dehydration is caused by a decreased fluid intake, increased sweating due to hot, humid weather, and an increase in physical activity without increasing fluids. Other causes can include fever, gastrointestinal issues such as vomiting and diarrhea, or viral illness such as rotavirus and norovirus.  

Signs of dehydration include:

• Dry mouth and lips
• No tears when crying
• Decrease in urine out-put
• Urine that is no longer light straw-colored

Some children will cooperate when you tell them to drink more fluids. Other children may need a bit more coaxing. Try these ideas to encourage your child to increase their fluid intake:

• Novelty straws
• Decorative cups
• Popsicles made with Kool-Aid or Crystal Light (properly diluted)
• Caffeine-free ice tea
• Snow cones (if you purchase commercially made ice from a snow cone vendor, please confirm the ice is sugar-free)
• Sugar free Jell-O also counts as a liquid, but it is also a protein and should only be used as part of the meal plan
• Stickers and other reward systems — set a specific intake as the goal, and turn it into a game

Remember, if your child is showing signs of dehydration, you should take them to the emergency room for evaluation. If intravenous fluids are required, a saline solution should be used. Make sure you tell the emergency room medical team that your child is on the ketogenic diet and that they should avoid carbohydrate-containing intravenous fluids.

If you have questions or concerns about your child’s fluid intake, please contact any member of the Dietary Treatment Program team at 215-590-1719.