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Clinical Trial Details — Status: Completed

Administrative data

NCT number NCT03982602
Other study ID # 2014675
Secondary ID
Status Completed
Phase Early Phase 1
First received
Last updated
Start date July 4, 2019
Est. completion date April 30, 2024

Study information

Verified date May 2024
Source University of Missouri-Columbia
Contact n/a
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

Traumatic Brain Injury is a major health concern in United States. There is a un-met need to develop new therapeutic options for faster neuron recovery without causing significant side effects. The role of ketones in neuronal recovery has been studied and has been found to be useful in decreasing size of contusion. The present study aims to study the safety and feasibility profile of ketogenic diet.


Description:

Traumatic Brain Injury (TBI) is a major health concern for United States contributing nearly one-third of injury-related deaths in United States. The Centers for Disease Control and Prevention (CDC) estimates that 1.7 million people in the United States sustain a TBI each year. It is responsible for significant disabilities and the total cost of productivity loss was estimated to be $76.5 billion in the United States in 2004. Several animal models have demonstrated the effectiveness of ketones in brain injury to decrease the size of contusion, improving cortical ATP levels, reduced brain edema and cellular apoptosis. Ketones have been shown to be effective in neuromodulation in animal models. Evaluation of carbohydrate free diet has been done in traumatic brain injury patients and it was noted to not cause fluctuations in blood glucose. There is a need for safety and feasibility study of ketogenic diet in traumatic brain injury patients and to understand the effectiveness in neuromodulation in humans. The present study focuses on identifying the safety and feasibility of KD in traumatic brain injury patients. This pilot project data will be utilized to design future randomized clinical trials. Based on the safety data, further trials will be conducted to evaluate the effectiveness of KD in traumatic brain injury patients and its effectiveness in controlling elevated intracranial pressure. It will open the avenue for consideration of new treatment option for intracranial pressure management and functional recovery. From a nutrition perspective, Ketogenic diet might become the standard of care for this patient population.


Recruitment information / eligibility

Status Completed
Enrollment 15
Est. completion date April 30, 2024
Est. primary completion date April 30, 2024
Accepts healthy volunteers No
Gender All
Age group 18 Years and older
Eligibility Inclusion Criteria: 1. Severe Traumatic Brain Injury 2. GCS<= 8 with severe head injury 3. Age more than 18years Exclusion Criteria: 1. Diabetic Ketoacidosis 2. Unstable metabolic condition (persistent hyponatremia, hypernatremia, hypoglycemia, hypocalcemia, acidosis) 3. Cardiorespiratory or hemodynamic instability 4. Coagulopathy 5. Pancreatitis 6. Liver Failure 7. Severe hyperlipidemia 8. Inability to tolerate enteral feeds including ileus 9. Known Fatty acid oxidation disorder or pyruvate carboxylase deficiency 10. Any terminally ill patient with poor brain stem reflexes and mortality within 24h of admission. 11. Pregnant Females

Study Design


Intervention

Other:
Ketogenic diet
Subjects will be provided with the Ketogenic diet in the form of tube feeds once the decision is made to start the patient on diet.

Locations

Country Name City State
United States University of Missouri Hospital Columbia Missouri

Sponsors (1)

Lead Sponsor Collaborator
University of Missouri-Columbia

Country where clinical trial is conducted

United States, 

Outcome

Type Measure Description Time frame Safety issue
Primary Effect of Ketogenic Diet on Intracranial Pressure Intracranial Pressure will be measured hourly and it will be trended daily. Baseline, till patient on KD (maximim 1 month)
Primary Development of Ketosis in blood Serum beta-hydroxybutyrate will be done alternate day to assess the level of ketosis in blood. Baseline, till patient on KD ( maximum 1month)
Primary Excretion of Ketones in Urine Urine Ketones will be measured alternate day to assess the level of ketosis Baseline, till patient on KD (maximum 1 month)
Secondary Evaluate change in the neurological exam Neurological exam will be documented with Glasgow Coma Scale. Baseline, before discharge from ICU
Secondary Evaluate subjects with gastro-intestinal adverse effects Adverse effects like Diarrhea, vomiting, abdominal distension (ileus), abdominal tenderness will be monitored. Baseline, till patient on KD (Maximum 1month)
Secondary Evaluate subjects for muscle wasting Urinary Nitrogen and urinary creatinine will be measured alternate day to look for muscle wasting. Baseline, till patient on Kd (Maximum 1month)
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