Normal (unforced) hydration and urine output is encouraged.
We advise patients to drink when thirsty and not to force the fluid intake. Recall that we already administer 2 liters of fluid per day through the KEN infusion pump. Diuresis accentuates the urinary loss of ketone bodies, corresponding to a small additional loss of unnecessary calories. Since the urinary levels of ketones during KEN is very low, even doubling the loss of urinary ketone is not a huge factor and can entail a greater sacrifice for patients who are already subjected to frequent urination, especially at night.
Some patients tend to drink fluids heavily even though we do not recommend it. This can lead to a reduction in the ketonuria that is recorded daily. Recall that the urine dipstick measures the ketone concentration, not the total amount of ketones eliminated. In principle a value 2+ of Ketur test is to be considered acceptable.