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Objectives: To retrospectively assess the incidence of high values of beta hydroxybutyrate , acyl carnitine and , low  values of bicarbonate (BIC), selenium, magnesium, zinc, phosphorus, in a cohort of supplemented patients on the ketogenic diet (KD) for medically intractable epilepsy who followed a specific protocol for laboratory (lab) testing every 3 months. To analyze effect of age, duration of exposure to KD, type of KD, route of KD intake [oral versus gastrostomy tube-(Gtube)] on lab abnormalities. Methods: Retrospective chart review and statistical analysis. Association between abnormal values (binary) and categorical variables was tested with Chi-square/Fisher’s exact test.    Alpha was set to 0.05 for all univariate tests.  Statistical analyses were performed in SAS 9.4.Results: 91 patients included. Average duration on diet : 46.73 months (IQR 18.8-75.5 months). Most patients were on classic KD (81 KD- 59% on 4:1 ratio). 74% were orally fed and 70% completed lab visits to the 12-month mark. There was no association between abnormal values with duration of exposure, type of diet, route of administration. Younger children were more likely to have low BIC, high acyl carnitine. Older children were more likely to have low phosphorus. Less than 15% patients reported clinical changes to suggest deficiency in vitamins/ minerals and in < 11% cases was an actionable laboratory parameter found.Significance:  First study documenting real-life incidence of selected tests being abnormal when following consensus guidelines. Elimination of tests with low yield will result in cost savings of up to $USD 185 per visit.

intractable epilepsy, ketogenic diet, consensus guidelines, laboratory testing